Healthcare Provider Details

I. General information

NPI: 1225913908
Provider Name (Legal Business Name): ISIDORA TERESITA ECHENIQUE BERTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 WISCONSIN AVE NW STE 300
WASHINGTON DC
20016-4606
US

IV. Provider business mailing address

3801 CONNECTICUT AVE NW
WASHINGTON DC
20008-4530
US

V. Phone/Fax

Practice location:
  • Phone: 202-536-4414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGPC200001782
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: