Provider Demographics
NPI:1083753354
Name:BEDUHN, KENT ROBERT (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:ROBERT
Last Name:BEDUHN
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10702 LOMBARDY RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1631
Mailing Address - Country:US
Mailing Address - Phone:301-754-0122
Mailing Address - Fax:301-754-0133
Practice Address - Street 1:10702 LOMBARDY RD
Practice Address - Street 2:CREATIVE CHANGE THERAPY CENTER LLP
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1631
Practice Address - Country:US
Practice Address - Phone:301-754-0122
Practice Address - Fax:301-754-0133
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD056591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical