Provider Demographics
NPI:1861771479
Name:GOTEL, DOUGLAS LEE (MSW, LICSW)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:LEE
Last Name:GOTEL
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5207 JAY ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5529
Mailing Address - Country:US
Mailing Address - Phone:202-430-5461
Mailing Address - Fax:
Practice Address - Street 1:50 E ST SE
Practice Address - Street 2:STE. 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2620
Practice Address - Country:US
Practice Address - Phone:202-430-5461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500787821041C0700X
DCLG500785191041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool