Provider Demographics
NPI:1275370777
Name:DIEVENDORF, BRITANY
Entity type:Individual
Prefix:
First Name:BRITANY
Middle Name:
Last Name:DIEVENDORF
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 1:20410 OBSERVATION DR STE 212
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4068
Mailing Address - Country:US
Mailing Address - Phone:240-296-6035
Mailing Address - Fax:
Practice Address - Street 1:20410 OBSERVATION DR STE 212
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4068
Practice Address - Country:US
Practice Address - Phone:240-296-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool