=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598774127
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADELE M ASIMOW PHD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 10/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19517 GALLATIN CT
-----------------------------------------------------
City | MONTGOMERY VILLAGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-977-5477
-----------------------------------------------------
Fax | 301-990-7289
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19517 GALLATIN CT
-----------------------------------------------------
City | MONTGOMERY VILLAGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-977-5477
-----------------------------------------------------
Fax | 301-990-7289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OF CORPORATION
-----------------------------------------------------
Name | DR. ADELE MAN KUEN ASIMOW
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 301-977-5477
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 569
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------