Provider Demographics
NPI:1942325683
Name:ELDER, PETRA ALICE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PETRA
Middle Name:ALICE
Last Name:ELDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10805 TORRANCE DR
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2800
Mailing Address - Country:US
Mailing Address - Phone:301-789-1031
Mailing Address - Fax:
Practice Address - Street 1:7013-A BROOKVILLE ROAD
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3263
Practice Address - Country:US
Practice Address - Phone:301-951-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical