MEDICARE: DR. NINA LEORA KAYCE PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	04799	MD

General Provider Information

NPI Number	:	1669763314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NINA LEORA KAYCE PSY.D.

Provider Business Mailing Address
First Line	:	1708 W ROGERS AVE
Second Line	:	MT. WASHINGTON PEDIATRIC HOSPITAL - PSYCHOLOGY
City	:	BALTIMORE
State	:	MD
Zip	:	21209-4545
Country	:	US
Telephone Number	:	410-578-5073
Fax Number	:	410-367-4197

Provider Business Practice Location Address
First Line	:	1708 W ROGERS AVE
Second Line	:	MT. WASHINGTON PEDIATRIC HOSPITAL - PSYCHOLOGY
City	:	BALTIMORE
State	:	MD
Zip	:	21209-4545
Country	:	US
Telephone Number	:	410-578-5073
Fax Number	:	410-367-4197

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2011
Last Update Date	:	04/29/2011

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