Provider Demographics
NPI:1013407196
Name:DEPETRILLO, CATHERINE (MA, MT-BC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:DEPETRILLO
Suffix:
Gender:F
Credentials:MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 CALIFORNIA ST NW APT 20A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-1822
Mailing Address - Country:US
Mailing Address - Phone:518-312-7512
Mailing Address - Fax:
Practice Address - Street 1:4719 HAMPDEN LN STE 100
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-656-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2024-08-01
Deactivation Date:2018-09-13
Deactivation Code:
Reactivation Date:2024-08-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health