Healthcare Provider Details

I. General information

NPI: 1821465030
Provider Name (Legal Business Name): SARAH M. WENTLING PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH SWENSON PSYD

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 TYRONE CIR
BALTIMORE MD
21212
US

IV. Provider business mailing address

228 TYRONE CIR
BALTIMORE MD
21212
US

V. Phone/Fax

Practice location:
  • Phone: 410-324-3527
  • Fax:
Mailing address:
  • Phone: 443-857-0425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6013
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06013
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: