Healthcare Provider Details

I. General information

NPI: 1891652558
Provider Name (Legal Business Name): CAROLINE JIANG ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2644 RIVA RD
ANNAPOLIS MD
21401-7427
US

IV. Provider business mailing address

3528 COVENTRY COURT DR
ELLICOTT CITY MD
21042-2178
US

V. Phone/Fax

Practice location:
  • Phone: 410-222-5000
  • Fax:
Mailing address:
  • Phone: 443-472-0653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number39150
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: