Provider Demographics
NPI:1194303727
Name:SAMIRABETULALLC
Entity type:Organization
Organization Name:SAMIRABETULALLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SKLAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-350-4966
Mailing Address - Street 1:3011 IONA TER
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-3413
Mailing Address - Country:US
Mailing Address - Phone:410-350-4966
Mailing Address - Fax:
Practice Address - Street 1:2324 W. JOPPA RPAD
Practice Address - Street 2:SUITE 130
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-2109
Practice Address - Country:US
Practice Address - Phone:410-350-4966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)