Healthcare Provider Details

I. General information

NPI: 1962220152
Provider Name (Legal Business Name): SELIMA NAIMOON JUMARALI PHD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N JEFFERSON ST STE 202
FREDERICK MD
21701-4865
US

IV. Provider business mailing address

3912 COLBORNE RD
BALTIMORE MD
21229-1901
US

V. Phone/Fax

Practice location:
  • Phone: 240-750-6467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberA01062
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: