Provider Demographics
NPI:1104003417
Name:THE BETHESDA GROUP PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:THE BETHESDA GROUP PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRADO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-718-4544
Mailing Address - Street 1:7988 OLD GEORGETOWN RD
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2481
Mailing Address - Country:US
Mailing Address - Phone:301-718-4544
Mailing Address - Fax:301-718-4545
Practice Address - Street 1:7988 OLD GEORGETOWN RD
Practice Address - Street 2:SUITE 8A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2481
Practice Address - Country:US
Practice Address - Phone:301-718-4544
Practice Address - Fax:301-718-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04249103TC0700X
MD03384103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty