Provider Demographics
NPI:1477918159
Name:BERSEH, EMMANUELA
Entity type:Individual
Prefix:
First Name:EMMANUELA
Middle Name:
Last Name:BERSEH
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 1:6931 SHEPHERD ST
Mailing Address - Street 2:6931 SHERHPERD STREET
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2533
Mailing Address - Country:US
Mailing Address - Phone:240-898-8652
Mailing Address - Fax:
Practice Address - Street 1:6931 SHEPHERD ST
Practice Address - Street 2:6931 SHERHPERD STREET
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2533
Practice Address - Country:US
Practice Address - Phone:240-898-8652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator