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General NPI Number Information
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NPI Number | 1619168366
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Entity Type | Organization
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Legal Business Name | MIRIAM BEADLE, PH.D.
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 3000 CONNECTICUT AVE NW SUITE #136
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City | WASHINGTON
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State | DC
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Zip | 20008-2509
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Country | US
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Telephone | 202-536-5602
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 638
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City | COLUMBIA
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State | MD
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Zip | 21045-0638
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Country | US
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Telephone | 202-536-5602
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CARLA SMITH
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Credential |
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Telephone | 202-536-5602
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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 | PSY1000047
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License Number State | DC
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