Provider Demographics
NPI:1568003085
Name:ARIELLE SHUGOLL PSYD LLC
Entity Type:Organization
Organization Name:ARIELLE SHUGOLL PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIELLE
Authorized Official - Middle Name:GESA
Authorized Official - Last Name:SHUGOLL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:240-780-8572
Mailing Address - Street 1:2212 HERMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2870
Mailing Address - Country:US
Mailing Address - Phone:301-412-0856
Mailing Address - Fax:
Practice Address - Street 1:8737 COLESVILLE RD STE 304
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3921
Practice Address - Country:US
Practice Address - Phone:240-780-8572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD984025700Medicaid