Provider Demographics
NPI:1922611169
Name:DEWERD, CAROLINE FAITH
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:FAITH
Last Name:DEWERD
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 1:4638 BATTENBURG LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6267
Mailing Address - Country:US
Mailing Address - Phone:763-742-9339
Mailing Address - Fax:
Practice Address - Street 1:4638 BATTENBURG LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6267
Practice Address - Country:US
Practice Address - Phone:763-742-9339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool