Provider Demographics
NPI:1821196247
Name:SUMMERS, GERTRUDE BEATA (PHD)
Entity Type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:BEATA
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10048 COLEBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1807
Mailing Address - Country:US
Mailing Address - Phone:301-251-8848
Mailing Address - Fax:
Practice Address - Street 1:10048 COLEBROOK AVE
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1807
Practice Address - Country:US
Practice Address - Phone:301-251-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02097103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist