Provider Demographics
NPI:1376669382
Name:NEALE, NORAH C (PHD)
Entity Type:Individual
Prefix:DR
First Name:NORAH
Middle Name:C
Last Name:NEALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 COLESVILLE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4327
Mailing Address - Country:US
Mailing Address - Phone:301-588-0305
Mailing Address - Fax:
Practice Address - Street 1:8811 COLESVILLE RD STE 102
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4327
Practice Address - Country:US
Practice Address - Phone:301-588-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03217103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD894152Medicare ID - Type Unspecified