Healthcare Provider Details

I. General information

NPI: 1609624907
Provider Name (Legal Business Name): HAREGNESH HAILE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 HOLLY AVE STE 400
ANNAPOLIS MD
21401-3152
US

IV. Provider business mailing address

2448 HOLLY AVE STE 400
ANNAPOLIS MD
21401-3152
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-9200
  • Fax:
Mailing address:
  • Phone: 410-753-6119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number07471
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: