Provider Demographics
NPI:1154896157
Name:WERSTEIN, JACK (MA, LPC)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:WERSTEIN
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 CONNECTICUT AVE NW APT 605
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-4315
Mailing Address - Country:US
Mailing Address - Phone:202-506-3240
Mailing Address - Fax:
Practice Address - Street 1:1801 COLUMBIA RD NW STE 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2031
Practice Address - Country:US
Practice Address - Phone:202-506-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC15104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPRC15104OtherDC-DOH