Provider Demographics
NPI:1518518588
Name:DEBERRY-SUMNER, BETTY JEAN
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:DEBERRY-SUMNER
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 1:20517 ABRAMS CT
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-2519
Mailing Address - Country:US
Mailing Address - Phone:301-257-4222
Mailing Address - Fax:
Practice Address - Street 1:10410 KENSINGTON PKWY STE 203
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2947
Practice Address - Country:US
Practice Address - Phone:240-324-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9766101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health