Provider Demographics
NPI:1609406248
Name:THE LUDIC GROUP
Entity type:Organization
Organization Name:THE LUDIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DANG
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:703-304-7082
Mailing Address - Street 1:1401 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-2762
Mailing Address - Country:US
Mailing Address - Phone:703-304-7082
Mailing Address - Fax:
Practice Address - Street 1:1350 CONNECTICUT AVE NW STE 307
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1738
Practice Address - Country:US
Practice Address - Phone:202-630-0458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty