Provider Demographics
NPI:1376768028
Name:BEN-AMI, UZI (PHD)
Entity Type:Individual
Prefix:MR
First Name:UZI
Middle Name:
Last Name:BEN-AMI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WATTS BRANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2913
Mailing Address - Country:US
Mailing Address - Phone:301-424-1941
Mailing Address - Fax:301-315-0219
Practice Address - Street 1:205 WATTS BRANCH PKWY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2913
Practice Address - Country:US
Practice Address - Phone:301-424-1941
Practice Address - Fax:301-315-0219
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01074103T00000X
DCPFY1152103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD648690Medicare ID - Type Unspecified
DC648690Medicare ID - Type Unspecified