Provider Demographics
NPI:1043587272
Name:BEYDER-KAMJOU, IRINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:BEYDER-KAMJOU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11005 TARA RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1345
Mailing Address - Country:US
Mailing Address - Phone:301-299-0077
Mailing Address - Fax:
Practice Address - Street 1:11005 TARA RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1345
Practice Address - Country:US
Practice Address - Phone:301-299-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM195106H00000X
DCLMFT000139106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist