Healthcare Provider Details

I. General information

NPI: 1558227447
Provider Name (Legal Business Name): SARA GLIESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2644 RIVA RD
ANNAPOLIS MD
21401-7427
US

IV. Provider business mailing address

1582 ELBERTA CT
SEVERN MD
21144-1000
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number39951
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: