Provider Demographics
NPI:1619168366
Name:MIRIAM BEADLE, PH.D.
Entity Type:Organization
Organization Name:MIRIAM BEADLE, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-536-5602
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-0638
Mailing Address - Country:US
Mailing Address - Phone:202-536-5602
Mailing Address - Fax:
Practice Address - Street 1:3000 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE #136
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2509
Practice Address - Country:US
Practice Address - Phone:202-536-5602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP65263Medicare UPIN
DC492069Medicare PIN