Provider Demographics
NPI:1184890964
Name:DEITZ, VIVIEN B (MSW LCSWC)
Entity type:Individual
Prefix:
First Name:VIVIEN
Middle Name:B
Last Name:DEITZ
Suffix:
Gender:F
Credentials:MSW LCSWC
Other - Prefix:
Other - First Name:VIVIEN
Other - Middle Name:B
Other - Last Name:DEITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW LCSWC
Mailing Address - Street 1:10726 BREWER HOUSE ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3420
Mailing Address - Country:US
Mailing Address - Phone:301-770-1111
Mailing Address - Fax:301-770-0260
Practice Address - Street 1:10726 BREWER HOUSE ROAD
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3420
Practice Address - Country:US
Practice Address - Phone:301-770-1111
Practice Address - Fax:301-770-0260
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD052211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical