Provider Demographics
NPI:1194428037
Name:NDIFON, CARINE NJENYOH (CSW)
Entity type:Individual
Prefix:
First Name:CARINE
Middle Name:NJENYOH
Last Name:NDIFON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 LAKEHOUSE RD APT 24
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3329
Mailing Address - Country:US
Mailing Address - Phone:346-232-6377
Mailing Address - Fax:
Practice Address - Street 1:2124 MARTIN LUTHER KING JR AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH EAST
Practice Address - State:DC
Practice Address - Zip Code:20002
Practice Address - Country:US
Practice Address - Phone:202-563-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 251S00000X, 171M00000X
DCHHA200003210374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide