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General NPI Number Information
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NPI Number | 1104305218
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Entity Type | Individual
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Provider Name | SI SI HAN PHD, ABPP
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Gender | Female
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 3300 N RIDGE RD STE 230
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-3387
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Country | US
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Telephone | 410-988-2192
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Fax | 410-988-2927
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Provider Business Mailing Address
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Address Line | 3300 N RIDGE RD STE 230
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-3387
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Country | US
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Telephone | 410-988-2192
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Fax | 410-988-2927
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 06921
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810006276
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License Number State | VA
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