Individual provider Active NPI

Eleonora Sadikova

  • Mental Health Counselor
  • Rockville, MD
National Provider Identifier
1972039634
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
9707 Key West Ave Ste 100
Rockville, MD 20850-3992
Phone
(240) 750-6467
NPI assigned
May 2, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 0810008678 VA
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

9707 Key West Ave Ste 100
Rockville, MD 20850-3992

Mailing address

4132 E Jack Jouett Rd
Louisa, VA 23093-3140
Phone (703) 405-9723

Other practice location 1

4132 E Jack Jouett Rd
Louisa, VA 23093-3140
Phone (703) 405-9723

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
0810008678VAMDClinical Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1493683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1972039634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4132 E JACK JOUETT RD",
            "city": "LOUISA",
            "state": "VA",
            "postal_code": "230933140",
            "telephone_number": "703-405-9723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9707 KEY WEST AVE STE 100",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503992",
            "telephone_number": "240-750-6467"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4132 E Jack Jouett Rd",
            "address_purpose": "LOCATION",
            "city": "Louisa",
            "state": "VA",
            "postal_code": "230933140",
            "country_code": "US",
            "telephone_number": "703-405-9723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SADIKOVA",
        "first_name": "ELEONORA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-02",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810008678",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.