Provider Demographics
NPI:1215296157
Name:MABOH, LILIAN
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:
Last Name:MABOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 NEW YORK AVE NE
Mailing Address - Street 2:228
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1848
Mailing Address - Country:US
Mailing Address - Phone:202-832-8340
Mailing Address - Fax:
Practice Address - Street 1:650 PENNSYLVANIA AVE SE STE 330
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4397
Practice Address - Country:US
Practice Address - Phone:202-864-4184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-13
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1044197163W00000X
DCNP1044197364SP0812X
374U00000X
MDR217417363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Community
No374U00000XNursing Service Related ProvidersHome Health Aide