Provider Demographics
NPI:1891260006
Name:INDIVIDUALIZED PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:INDIVIDUALIZED PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YAAKOV
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUGARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:410-999-8060
Mailing Address - Street 1:5603 NEWBURY ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3603
Mailing Address - Country:US
Mailing Address - Phone:410-999-8060
Mailing Address - Fax:410-787-5454
Practice Address - Street 1:5603 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3603
Practice Address - Country:US
Practice Address - Phone:410-999-8060
Practice Address - Fax:410-787-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty