MEDICARE: BERTHA WHITE LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	15403	MD
2	1041C0700X	Clinical Social Worker	15403	MD

General Provider Information

NPI Number	:	1235557570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERTHA WHITE LCSW-C

Provider Business Mailing Address
First Line	:	605 POST OFFICE RD STE 301
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-1913
Country	:	US
Telephone Number	:	240-346-0934
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 POST OFFICE RD STE 301
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-1913
Country	:	US
Telephone Number	:	240-346-0934
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2014
Last Update Date	:	11/21/2022

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Directions to “ BERTHA WHITE LCSW-C” Practice Location

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