Healthcare Provider Details

I. General information

NPI: 1114167087
Provider Name (Legal Business Name): KRISTEN M TARQUIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 BAY DALE DR # 333
ARNOLD MD
21012-2325
US

IV. Provider business mailing address

1290 BAY DALE DR # 333
ARNOLD MD
21012-2325
US

V. Phone/Fax

Practice location:
  • Phone: 443-584-3532
  • Fax:
Mailing address:
  • Phone: 443-584-3532
  • Fax: 866-520-3465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number04469
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04469
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: