Healthcare Provider Details

I. General information

NPI: 1679227698
Provider Name (Legal Business Name): CATHY BERRY LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3829 FERRARA DR
SILVER SPRING MD
20906-4765
US

IV. Provider business mailing address

3829 FERRARA DR
SILVER SPRING MD
20906-4765
US

V. Phone/Fax

Practice location:
  • Phone: 202-306-6516
  • Fax:
Mailing address:
  • Phone: 202-306-6516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG50083819
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: