Provider Demographics
NPI:1548802531
Name:NARGIZ, ADISON
Entity Type:Individual
Prefix:MS
First Name:ADISON
Middle Name:
Last Name:NARGIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410B CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:MD
Mailing Address - Zip Code:21776-8401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410B CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:MD
Practice Address - Zip Code:21776-8401
Practice Address - Country:US
Practice Address - Phone:443-739-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician