Healthcare Provider Details

I. General information

NPI: 1174182901
Provider Name (Legal Business Name): EFRAIM S ESHAGHIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16220 FREDERICK RD
GAITHERSBURG MD
20877-4039
US

IV. Provider business mailing address

2700 JEREMY CT APT F
BALTIMORE MD
21209-3013
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-1563
  • Fax:
Mailing address:
  • Phone: 818-935-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM899
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMFT000273
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: