Provider Demographics
NPI:1558483073
Name:MEERBAUM, MONICA LEONIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:LEONIE
Last Name:MEERBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MONICA
Other - Middle Name:LEONIE
Other - Last Name:MEERBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4915 SAINT ELMO AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6019
Mailing Address - Country:US
Mailing Address - Phone:301-587-6211
Mailing Address - Fax:301-986-0104
Practice Address - Street 1:4915 SAINT ELMO AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6019
Practice Address - Country:US
Practice Address - Phone:301-587-6211
Practice Address - Fax:301-986-0104
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01518103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD134303Medicare ID - Type Unspecified