Healthcare Provider Details

I. General information

NPI: 1376658427
Provider Name (Legal Business Name): HOLLY BETH SUDDITH LCSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY BETH BERILLA

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11670 OLD NATIONAL PIKE SUITE 103
NEW MARKET MD
21774
US

IV. Provider business mailing address

27510 MOUNT RADNOR DR
DAMASCUS MD
20872
US

V. Phone/Fax

Practice location:
  • Phone: 301-865-2226
  • Fax:
Mailing address:
  • Phone: 240-723-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10628
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: