MEDICARE: SIMA BAKHTIAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	LGP15923	MD
2	101YM0800X	Mental Health Counselor	LGP15923	MD

General Provider Information

NPI Number	:	1215823521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMA BAKHTIAR

Provider Business Mailing Address
First Line	:	1602 EDWIN CT
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21015-1559
Country	:	US
Telephone Number	:	443-616-7441
Fax Number	:

Provider Business Practice Location Address
First Line	:	6910 HOLABIRD AVE
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222-1788
Country	:	US
Telephone Number	:	410-656-2444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2025
Last Update Date	:	06/13/2025

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Directions to “ SIMA BAKHTIAR ” Practice Location

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