Provider Demographics
NPI:1093425845
Name:BELAY, EYERUSALEM T
Entity Type:Individual
Prefix:
First Name:EYERUSALEM
Middle Name:T
Last Name:BELAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 DILSTON RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2202
Mailing Address - Country:US
Mailing Address - Phone:571-277-5013
Mailing Address - Fax:
Practice Address - Street 1:1304 DILSTON RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2202
Practice Address - Country:US
Practice Address - Phone:571-277-5013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical