Provider Demographics
NPI:1942257142
Name:CLASSEN-MILLER, GERTRUD IRMGARD (LCSW-C)
Entity Type:Individual
Prefix:
First Name:GERTRUD
Middle Name:IRMGARD
Last Name:CLASSEN-MILLER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13111 MORAN CT
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3922
Mailing Address - Country:US
Mailing Address - Phone:301-977-0824
Mailing Address - Fax:240-597-0794
Practice Address - Street 1:13111 MORAN CT
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-3922
Practice Address - Country:US
Practice Address - Phone:301-977-0824
Practice Address - Fax:240-597-0794
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD071971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD491403Medicare ID - Type UnspecifiedTRAILBLAZER