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NPI Code Detail

MEDICARE: BARRIE KRELLEN GOCHMAN LCSW-C

MEDICARE: BARRIE KRELLEN GOCHMAN 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
11041C0700XClinical Social Worker08647MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1296803OTHERMHN,TRICARE
280740001OTHERBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1740333186
Entity Type Code : Individual
Provider Name (Legal Business Name) : BARRIE KRELLEN GOCHMAN LCSW-C
Provider Business Mailing Address
First Line : 3750 UNIVERSITY BLVD W
Second Line : SUITE 303
City : KENSINGTON
State : MD
Zip : 20895-2136
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3750 UNIVERSITY BLVD W
Second Line : SUITE 303
City : KENSINGTON
State : MD
Zip : 20895-2136
Country : US
Telephone Number : 301-466-1163
Fax Number : 301-933-7588
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2007
Last Update Date : 10/21/2016

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