Provider Demographics
NPI:1689436024
Name:EAZIZAYENE, SAIDA
Entity Type:Individual
Prefix:
First Name:SAIDA
Middle Name:
Last Name:EAZIZAYENE
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 1:325 ELLINGTON BLVD # 509
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4591
Mailing Address - Country:US
Mailing Address - Phone:703-656-1067
Mailing Address - Fax:
Practice Address - Street 1:325 ELLINGTON BLVD # 509
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-4591
Practice Address - Country:US
Practice Address - Phone:703-656-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty