Healthcare Provider Details

I. General information

NPI: 1508964271
Provider Name (Legal Business Name): MARK ARENAS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST MH-116
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

10 N GREENE ST BT/MH/116
BALTIMORE MD
21201-1524
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7000
  • Fax:
Mailing address:
  • Phone: 410-605-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number02229
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: