Provider Demographics
NPI:1205930518
Name:BRESLOW, HARRIET K (LCSWC)
Entity type:Individual
Prefix:MRS
First Name:HARRIET
Middle Name:K
Last Name:BRESLOW
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8712 HARNESS TRAIL
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854
Mailing Address - Country:US
Mailing Address - Phone:301-983-1321
Mailing Address - Fax:301-983-4953
Practice Address - Street 1:8712 HARNESS TRAIL
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854
Practice Address - Country:US
Practice Address - Phone:301-983-1321
Practice Address - Fax:301-983-4953
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02565104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD225-271-8000Medicaid
MD225-271-8000Medicaid