Provider Demographics
NPI:1982746038
Name:DOBBERTIN, ANN M (LCSW-C)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:DOBBERTIN
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 1:3320 STANFORD ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1948
Mailing Address - Country:US
Mailing Address - Phone:301-422-0101
Mailing Address - Fax:301-422-0101
Practice Address - Street 1:3320 STANFORD ST
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-1948
Practice Address - Country:US
Practice Address - Phone:301-422-0101
Practice Address - Fax:301-422-0101
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD059101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD646637Medicare ID - Type Unspecified