Active NPI
Sharon Shanti Issurdatt Dietsche, LCSW-C, LICSW
- Clinical Social Worker
- Silver Spring, MD
National Provider Identifier
1720236763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 16759
- Practice address
- 412 Silver Spring Ave
Silver Spring, MD 20910-4608 - Phone
- (301) 437-6869
- NPI assigned
- Sep 3, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 16759 | MD | Primary |
| Clinical Social Worker | 1041C0700X | LC50078900 | DC |
Addresses
Primary practice location
412 Silver Spring Ave
Silver Spring, MD 20910-4608
Mailing address
412 Silver Spring Ave
Silver Spring, MD 20910-4608
Phone (301) 437-6869
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0004834000 | Medicaid | FL | |
| 3352072 00 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC50078900 | DC | MD | Clinical Social Worker |
| 16759 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428364800000",
"number": "1720236763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "412 SILVER SPRING AVE",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209104608",
"telephone_number": "301-437-6869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 SILVER SPRING AVE",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209104608",
"telephone_number": "301-437-6869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETSCHE",
"first_name": "SHARON",
"middle_name": "SHANTI ISSURDATT",
"name_prefix": "Ms.",
"credential": "LCSW-C, LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-03",
"last_updated": "2015-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "16759",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "DC",
"license": "LC50078900",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0004834000",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3352072 00",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Silver Spring, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.