Provider Demographics
NPI:1972879286
Name:DIETZ, VERONICA L (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:L
Last Name:DIETZ
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:VERONICA
Other - Middle Name:LEE
Other - Last Name:ESTEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:172 OTHELLO CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7114
Mailing Address - Country:US
Mailing Address - Phone:347-744-7976
Mailing Address - Fax:
Practice Address - Street 1:10 DISTILLERY RD STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5344
Practice Address - Country:US
Practice Address - Phone:410-876-4800
Practice Address - Fax:410-876-4832
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079724-11041C0700X
MD125791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical