Provider Demographics
NPI:1568085314
Name:KAPLAN, MYRA ELLEN
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:ELLEN
Last Name:KAPLAN
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 1:1123 BETTSTRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-5537
Mailing Address - Country:US
Mailing Address - Phone:301-728-5307
Mailing Address - Fax:
Practice Address - Street 1:1123 BETTSTRAIL WAY
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-5537
Practice Address - Country:US
Practice Address - Phone:301-728-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3140103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical