MEDICARE: DR. SIDNEY WALTER BINKS III PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	03064	MD
2	103T00000X	Psychologist	PSY1773	DC
3	103T00000X	Psychologist	03064	MD
4	103TC0700X	Clinical Psychologist	PSY1773	DC
5	103TC0700X	Clinical Psychologist	03064	MD
6	103TF0200X	Forensic Psychologist	PSY1773	DC
7	103TF0200X	Forensic Psychologist	03064	MD
8	103TH0100X	Health Service Psychologist	PSY1773	DC
9	103TH0100X	Health Service Psychologist	03064	MD
10	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PSY1773	DC
11	103TM1800X	Intellectual & Developmental Disabilities Psychologist	03064	MD
12	103TP2701X	Group Psychotherapy Psychologist	PSY1773	DC
13	103TP2701X	Group Psychotherapy Psychologist	03064	MD
14	103TR0400X	Rehabilitation Psychologist	PSY1773	DC
15	103G00000X	Clinical Neuropsychologist	PSY1773	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03064	OTHER	MD	MARYLAND LICENSE #
2	PSY1773	OTHER	DC	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1841371291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIDNEY WALTER BINKS III PH.D.

Provider Business Mailing Address
First Line	:	3000 CONNECTICUT AVE NW
Second Line	:	STE 238
City	:	WASHINGTON
State	:	DC
Zip	:	20008-2531
Country	:	US
Telephone Number	:	202-255-5187
Fax Number	:	202-234-6373

Provider Business Practice Location Address
First Line	:	3000 CONNECTICUT AVE NW
Second Line	:	STE 238
City	:	WASHINGTON
State	:	DC
Zip	:	20008-2531
Country	:	US
Telephone Number	:	202-255-5187
Fax Number	:	202-234-6373

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	12/07/2018

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