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General NPI Number Information
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NPI Number | 1861072373
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Entity Type | Individual
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Provider Name | MS. BERNADETTE OLIVIA GORMAN
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Gender | Female
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 1140 VARNUM ST NE STE 203
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City | WASHINGTON
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State | DC
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Zip | 20017-2153
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Country | US
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Telephone | 202-525-5175
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Fax |
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Provider Business Mailing Address
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Address Line | 6500 AMERICA BLVD APT 406
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City | HYATTSVILLE
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State | MD
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Zip | 20782-2351
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Country | US
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Telephone | 410-714-2250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LG50083414
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License Number State | DC
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