1518913615 NPI number — HARVEY BRIAN BERTHIAUME L.C.S.W.-C.

Table of content: HARVEY BRIAN BERTHIAUME L.C.S.W.-C. (NPI 1518913615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518913615 NPI number — HARVEY BRIAN BERTHIAUME L.C.S.W.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERTHIAUME
Provider First Name:
HARVEY
Provider Middle Name:
BRIAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.-C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518913615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9055 SHADY GROVE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20877-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-330-0400
Provider Business Practice Location Address Fax Number:
301-948-4333
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  06887 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 23070019 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 376673 . This is a "UNITED HEALTHCARE-MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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