Provider Demographics
NPI:1558466813
Name:DANDRIDGE, BERYL K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BERYL
Middle Name:K
Last Name:DANDRIDGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BERYL
Other - Middle Name:K
Other - Last Name:BERKOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101
Mailing Address - Country:US
Mailing Address - Phone:703-707-0017
Mailing Address - Fax:703-904-1875
Practice Address - Street 1:435A CARLISLE DRIVE
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170
Practice Address - Country:US
Practice Address - Phone:703-707-0017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040037451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical