Provider Demographics
NPI:1225255102
Name:BARON, IDA SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:IDA
Middle Name:SUE
Last Name:BARON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:IDA
Other - Middle Name:SUE
Other - Last Name:BARON-STARKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:10116 WEATHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2173
Mailing Address - Country:US
Mailing Address - Phone:301-340-2119
Mailing Address - Fax:301-340-2119
Practice Address - Street 1:1830 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3292
Practice Address - Country:US
Practice Address - Phone:301-340-2119
Practice Address - Fax:301-340-2119
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02300103TC0700X, 103G00000X
VA0810002315103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist