Healthcare Provider Details

I. General information

NPI: 1851326243
Provider Name (Legal Business Name): JENNIFER LYNNE MORAN PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 N CHARLES ST SUITE 300
BALTIMORE MD
21204-5826
US

IV. Provider business mailing address

6535 N CHARLES ST SUITE 300
BALTIMORE MD
21204-5826
US

V. Phone/Fax

Practice location:
  • Phone: 410-938-5252
  • Fax: 410-938-5250
Mailing address:
  • Phone: 410-938-5252
  • Fax: 410-938-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04045
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: