Provider Demographics
NPI:1972693075
Name:ABT, WENDY RENEE (MSW)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:RENEE
Last Name:ABT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 HOPEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4221
Mailing Address - Country:US
Mailing Address - Phone:301-384-0117
Mailing Address - Fax:
Practice Address - Street 1:1917 HOPEFIELD RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-4221
Practice Address - Country:US
Practice Address - Phone:301-384-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD073081041C0700X
DCLC500782721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD81615Medicare ID - Type Unspecified