Healthcare Provider Details

I. General information

NPI: 1851702708
Provider Name (Legal Business Name): KATHERINE STREETER WRIGHT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE BLDG ROOM1661
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-5299
  • Fax: 410-550-1345
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-933-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number05898
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number05898
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: