Healthcare Provider Details

I. General information

NPI: 1871881037
Provider Name (Legal Business Name): CATHERINE MARY SULLIVAN-WINDT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WYNDHURST AVE STE 307A
BALTIMORE MD
21210-2419
US

IV. Provider business mailing address

600 WYNDHURST AVE STE 307A
BALTIMORE MD
21210-2419
US

V. Phone/Fax

Practice location:
  • Phone: 443-257-1812
  • Fax:
Mailing address:
  • Phone: 443-257-1812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number04691
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: