MEDICARE: HARVEY BRIAN BERTHIAUME L.C.S.W.-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	1041C0700X	Clinical Social Worker	06887	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23070019	OTHER	DC	BLUE CROSS BLUE SHIELD
2	376673	OTHER	MD	UNITED HEALTHCARE-MAMSI

General Provider Information

NPI Number	:	1518913615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARVEY BRIAN BERTHIAUME L.C.S.W.-C.

Provider Business Mailing Address
First Line	:	9055 SHADY GROVE CT
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1301
Country	:	US
Telephone Number	:	301-330-0400
Fax Number	:	301-948-4333

Provider Business Practice Location Address
First Line	:	9055 SHADY GROVE CT
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1301
Country	:	US
Telephone Number	:	301-330-0400
Fax Number	:	301-948-4333

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	07/08/2007

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