Healthcare Provider Details

I. General information

NPI: 1912526302
Provider Name (Legal Business Name): NIESHA BERTRAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 JOHNNYCAKE RD
WINDSOR MILL MD
21244-2418
US

IV. Provider business mailing address

7001 JOHNNYCAKE RD
WINDSOR MILL MD
21244-2418
US

V. Phone/Fax

Practice location:
  • Phone: 410-774-9840
  • Fax:
Mailing address:
  • Phone: 410-774-9840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA2608
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: