Provider Demographics
NPI:1720152598
Name:GOOD-WHITE, BETTY WENGER (LICSW MSW)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:WENGER
Last Name:GOOD-WHITE
Suffix:
Gender:F
Credentials:LICSW MSW
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:LOIS
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW MSW
Mailing Address - Street 1:KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
Mailing Address - Street 2:2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:2100 W PENNSLYVANIA AVE, NW
Practice Address - Street 2:KAISER PERMANENTE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3202
Practice Address - Country:US
Practice Address - Phone:202-721-2131
Practice Address - Fax:202-721-2121
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3018161041C0700X
MD053701041C0700X
VA09040031591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical