Healthcare Provider Details

I. General information

NPI: 1942257142
Provider Name (Legal Business Name): GERTRUD IRMGARD CLASSEN-MILLER LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 MORAN CT
NORTH POTOMAC MD
20878-3922
US

IV. Provider business mailing address

13111 MORAN CT
NORTH POTOMAC MD
20878-3922
US

V. Phone/Fax

Practice location:
  • Phone: 301-977-0824
  • Fax: 240-597-0794
Mailing address:
  • Phone: 301-977-0824
  • Fax: 240-597-0794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07197
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: