Healthcare Provider Details

I. General information

NPI: 1295360733
Provider Name (Legal Business Name): ATARA BEILAH SIEGEL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 ASHLAND AVE
BALTIMORE MD
21205-1531
US

IV. Provider business mailing address

18 SADDLEROCK CT
SILVER SPRING MD
20902-1611
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-2128
  • Fax:
Mailing address:
  • Phone: 301-928-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06868
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: