Provider Demographics
NPI:1528523446
Name:MARGOLIES, AVI-DAVID (PSYD)
Entity type:Individual
Prefix:DR
First Name:AVI-DAVID
Middle Name:
Last Name:MARGOLIES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:AVI
Other - Middle Name:
Other - Last Name:MARGOLIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:6279 PARK RD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4813
Mailing Address - Country:US
Mailing Address - Phone:917-617-1193
Mailing Address - Fax:
Practice Address - Street 1:1350 CONNECTICUT AVE NW STE 602
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1716
Practice Address - Country:US
Practice Address - Phone:202-642-3975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2023-02-05
Deactivation Date:2019-07-01
Deactivation Code:
Reactivation Date:2019-07-10
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001480103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical