Provider Demographics
NPI:1063601805
Name:BHAT, CHETANA
Entity type:Individual
Prefix:
First Name:CHETANA
Middle Name:
Last Name:BHAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10123 SENATE DR
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4367
Mailing Address - Country:US
Mailing Address - Phone:301-459-9118
Mailing Address - Fax:
Practice Address - Street 1:8737 COLESVILLE RD
Practice Address - Street 2:SUITE 700
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-7901
Practice Address - Country:US
Practice Address - Phone:301-588-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP198101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP198Medicaid