Provider Demographics
NPI:1275830192
Name:ASSEFAW, ALMAZ
Entity type:Individual
Prefix:MISS
First Name:ALMAZ
Middle Name:
Last Name:ASSEFAW
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 1:12826 OWENS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8252
Mailing Address - Country:US
Mailing Address - Phone:202-818-8656
Mailing Address - Fax:202-818-8656
Practice Address - Street 1:1110 BONIFANT ST STE 201F
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3358
Practice Address - Country:US
Practice Address - Phone:202-818-8656
Practice Address - Fax:202-818-8656
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-13
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169575363LF0000X, 363LP0808X
DCCN-1100338363LF0000X
MARN2336612363LF0000X
MDAC004657363LP0808X, 364SP0808X
DCRN961903363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health