Healthcare Provider Details

I. General information

NPI: 1144439605
Provider Name (Legal Business Name): JEANNE BERTOLI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MARYLAND AVE SW SUITE 800W
WASHINGTON DC
20024-2520
US

IV. Provider business mailing address

350 G ST SW #504N
WASHINGTON DC
20024-3129
US

V. Phone/Fax

Practice location:
  • Phone: 202-580-7492
  • Fax:
Mailing address:
  • Phone: 202-669-9272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: