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General NPI Number Information
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NPI Number | 1710171814
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Entity Type | Organization
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Legal Business Name | SCHOOL SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 4701 SANGAMORE RD STE S135
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City | BETHESDA
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State | MD
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Zip | 20816-2562
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Country | US
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Telephone | 301-656-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 4701 SANGAMORE RD STE S135
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City | BETHESDA
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State | MD
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Zip | 20816-2562
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Country | US
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Telephone | 301-656-5200
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DR. TERRY EDELSTEIN
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Credential |
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Telephone | 301-656-5200
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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