Provider Demographics
NPI:1871711275
Name:SURBECK, BETH S (PHD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:S
Last Name:SURBECK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ROLLING GREEN CT
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3909
Mailing Address - Country:US
Mailing Address - Phone:410-828-5332
Mailing Address - Fax:
Practice Address - Street 1:200 E JOPPA RD
Practice Address - Street 2:SUITE 108
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3150
Practice Address - Country:US
Practice Address - Phone:410-583-9253
Practice Address - Fax:410-583-9297
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03884103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist