Healthcare Provider Details

I. General information

NPI: 1811360472
Provider Name (Legal Business Name): MARISSA KAPLAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 PARK AVE
BALTIMORE MD
21201-4572
US

IV. Provider business mailing address

3505 ORCHARD SHADE RD
RANDALLSTOWN MD
21133-2457
US

V. Phone/Fax

Practice location:
  • Phone: 410-777-8130
  • Fax: 410-777-8134
Mailing address:
  • Phone: 732-925-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number05519
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: