Provider Demographics
NPI:1487308037
Name:BERTRAN COUNSELING LLC
Entity type:Organization
Organization Name:BERTRAN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-966-2268
Mailing Address - Street 1:3114 BENTON SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2539
Mailing Address - Country:US
Mailing Address - Phone:301-966-2268
Mailing Address - Fax:
Practice Address - Street 1:4405 E WEST HWY STE 408
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4535
Practice Address - Country:US
Practice Address - Phone:301-966-2268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904011644OtherLCSW LICENSE #
MD19265OtherLCSW-C LICENSE #