Provider Demographics
NPI:1629662952
Name:SIDBURY, NATALIE NICOLE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:NICOLE
Last Name:SIDBURY
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 1:207 LAKESIDE DR APT T2
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2911
Mailing Address - Country:US
Mailing Address - Phone:202-603-4957
Mailing Address - Fax:
Practice Address - Street 1:207 LAKESIDE DR APT T2
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2911
Practice Address - Country:US
Practice Address - Phone:202-603-4957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD221061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical