Provider Demographics
NPI:1295017424
Name:DEHGHAN, CARA DEPP (PSYD)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:DEPP
Last Name:DEHGHAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 HIDDEN FOREST CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3545
Mailing Address - Country:US
Mailing Address - Phone:971-352-2694
Mailing Address - Fax:
Practice Address - Street 1:491 WHETSTONE GLEN ST
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3337
Practice Address - Country:US
Practice Address - Phone:202-569-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001527103TC0700X
VA0810006135103TC0700X
OR2285103TC0700X
MD06275103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000WDBCHOtherGROUP MEDICARE NUMBER
OR164936Medicaid