Healthcare Provider Details

I. General information

NPI: 1821690322
Provider Name (Legal Business Name): BEWILBERTLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CONNECTICUT AVE NW STE 500
WASHINGTON DC
20036-1736
US

IV. Provider business mailing address

721 FARRAGUT PL NE
WASHINGTON DC
20017-2364
US

V. Phone/Fax

Practice location:
  • Phone: 240-391-7350
  • Fax:
Mailing address:
  • Phone: 617-962-2484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. DANETTE LAWRENCE
Title or Position: CLINICAL SOCIAL WORKER
Credential: LICSW, LCSW-C
Phone: 617-962-2484