Healthcare Provider Details

I. General information

NPI: 1932543162
Provider Name (Legal Business Name): TALYA KIM VAN DEN BERG LCSW-C, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TALYA KIM LAZAROW

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 WOODSIDE CT STE 350
COLUMBIA MD
21046-1042
US

IV. Provider business mailing address

6325 WOODSIDE CT STE 350
COLUMBIA MD
21046-1042
US

V. Phone/Fax

Practice location:
  • Phone: 410-910-9660
  • Fax:
Mailing address:
  • Phone: 410-910-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS25299
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number24084
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: