Provider Demographics
NPI:1477637700
Name:BEASLEY, DINARA M (MA)
Entity type:Individual
Prefix:
First Name:DINARA
Middle Name:M
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DINARA
Other - Middle Name:M
Other - Last Name:DJABBAROVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-0826
Mailing Address - Country:US
Mailing Address - Phone:301-862-4966
Mailing Address - Fax:301-862-5554
Practice Address - Street 1:21770 FDR BOULEVARD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:29653
Practice Address - Country:US
Practice Address - Phone:301-862-4966
Practice Address - Fax:301-862-5554
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01516Medicare ID - Type Unspecified
MD407LMedicare ID - Type Unspecified