MEDICARE: ARIELLE SHUGOLL PSYD LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568003085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIELLE SHUGOLL PSYD LLC

Provider Business Mailing Address
First Line	:	2212 HERMITAGE AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-2870
Country	:	US
Telephone Number	:	301-412-0856
Fax Number	:

Provider Business Practice Location Address
First Line	:	8737 COLESVILLE RD STE 304
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3921
Country	:	US
Telephone Number	:	240-780-8572
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. ARIELLE GESA SHUGOLL
Credential	:	PSYD
Telephone Number	:	240-780-8572

Provider Enumeration Date	:	10/06/2019
Last Update Date	:	10/06/2019

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