Provider Demographics
NPI:1407085111
Name:NEGOLA, SEAN M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:M
Last Name:NEGOLA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21407 UPPERMONT LN
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20882-4873
Mailing Address - Country:US
Mailing Address - Phone:301-977-7319
Mailing Address - Fax:
Practice Address - Street 1:21407 UPPERMONT LN
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20882-4873
Practice Address - Country:US
Practice Address - Phone:301-977-7319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3229103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical