Provider Demographics
NPI:1962224816
Name:NAKAMURA-PEEK, SARA RIE
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:RIE
Last Name:NAKAMURA-PEEK
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 1:4977 BATTERY LN UNIT 509
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4919
Mailing Address - Country:US
Mailing Address - Phone:704-996-9370
Mailing Address - Fax:
Practice Address - Street 1:640 E DIAMOND AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-5323
Practice Address - Country:US
Practice Address - Phone:240-805-0357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health