Basic Information
| Provider Information | |||||||||
| NPI: | 1720152598 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOOD-WHITE | ||||||||
| FirstName: | BETTY | ||||||||
| MiddleName: | WENGER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW MSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GOOD | ||||||||
| OtherFirstName: | BETTY | ||||||||
| OtherMiddleName: | LOIS | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LICSW MSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP | ||||||||
| Address2: | 2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018166660 | ||||||||
| FaxNumber: | 3018166308 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 W PENNSLYVANIA AVE, NW | ||||||||
| Address2: | KAISER PERMANENTE | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200373202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027212131 | ||||||||
| FaxNumber: | 2027212121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 01/30/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LC301816 | DC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 05370 | MD | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 0904003159 | VA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.