Provider Demographics
NPI:1023594017
Name:SHUGARMAN, YAAKOV (PSYD)
Entity type:Individual
Prefix:DR
First Name:YAAKOV
Middle Name:
Last Name:SHUGARMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 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:
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
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06088103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical