Provider Information for 1932543162
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TALYA KIM VAN DEN BERG LCSW-C, LCSW
Other Names:Former Name:TALYA KIM LAZAROWSex: Female
NPI: 1932543162
Last Updated: 2022-02-11
Certification Date: 2022-02-11
Certification Date: 2022-02-11
Details
| Name | Value | ||||||||||||
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| NPI | 1932543162 | ||||||||||||
| Enumeration Date | 2013-04-18 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3556 SPRIGG ST S FREDERICK, MD 21704-7935 United States Phone: 858-717-4214 | Fax: | ||||||||||||
| Primary Practice Address | 3556 SPRIGG ST S UNIT 53 FREDERICK, MD 21704-7935 United States Phone: 858-717-4214 | Fax: | ||||||||||||
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