Provider Demographics
NPI:1043664329
Name:SHARAT K. JAIN, PH.D. CLINICAL PSYCHOLOGIST
Entity Type:Organization
Organization Name:SHARAT K. JAIN, PH.D. CLINICAL PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHARAT
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-693-5513
Mailing Address - Street 1:10705 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4113
Mailing Address - Country:US
Mailing Address - Phone:301-693-5513
Mailing Address - Fax:301-765-3366
Practice Address - Street 1:3230 PENNSYLVANIA AVE SE
Practice Address - Street 2:SUITE 213
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3722
Practice Address - Country:US
Practice Address - Phone:301-693-5513
Practice Address - Fax:301-765-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty