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General NPI Number Information
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NPI Number | 1922642156
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Entity Type | Individual
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Provider Name | DIANE ELIZABETH BERTRAN LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 10/31/2019
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 4405 E WEST HWY STE 408
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City | BETHESDA
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State | MD
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Zip | 20814-4535
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Country | US
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Telephone | 301-966-2268
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Fax |
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Provider Business Mailing Address
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Address Line | 3114 BENTON SQUARE DR
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City | OLNEY
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State | MD
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Zip | 20832-2539
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Country | US
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Telephone | 301-966-2268
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19265
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License Number State | MD
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