Provider Demographics
NPI:1215309240
Name:PIURA GAITAN, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:PIURA GAITAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 WISCONSIN AVE STE 400W
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3224
Mailing Address - Country:US
Mailing Address - Phone:240-224-2527
Mailing Address - Fax:
Practice Address - Street 1:7315 WISCONSIN AVE STE 400W
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3224
Practice Address - Country:US
Practice Address - Phone:240-224-2527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000030991041C0700X
FLSW237101041C0700X
MD231001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036392800Medicaid