Provider Demographics
NPI:1548663826
Name:MCLEOD-PETERKIN, NADINE (LICSW)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:MCLEOD-PETERKIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8757 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20763-9715
Mailing Address - Country:US
Mailing Address - Phone:301-357-3705
Mailing Address - Fax:
Practice Address - Street 1:1214 I ST SE APT 11
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4103
Practice Address - Country:US
Practice Address - Phone:202-249-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC205078107101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12623553OtherCAQH PROVIDER