Doctor Name: | DR. SUDHA JAIN |
NPI Number: | 1164551446 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | PSY1000063 |
Business Practice Address: | 10705 River Rd Potomac, MD - 208544113 |
Business Phone Number: | 3017653344 |
Business Fax Number: | 3017653355 |
Mailing Address: | 10705 River Rd, POTOMAC |
State: | MD |
Postal Code: | 208544113 |
Phone Number: | 3017653344 |
Fax Number: | 3017653355 |
NPI Enumeration Date: | 03/05/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY1000063 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | DC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |