Healthcare Provider Details

I. General information

NPI: 1013407196
Provider Name (Legal Business Name): CATHERINE DEPETRILLO MA, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 08/01/2024
Certification Date:
Deactivation Date: 09/13/2018
Reactivation Date: 08/01/2024

III. Provider practice location address

4719 HAMPDEN LN STE 100
BETHESDA MD
20814
US

IV. Provider business mailing address

1840 CALIFORNIA ST NW APT 20A
WASHINGTON DC
20009-1822
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-4600
  • Fax:
Mailing address:
  • Phone: 518-312-7512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: