Healthcare Provider Details

I. General information

NPI: 1679629117
Provider Name (Legal Business Name): CAROLYN THERESA CALDWELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN THERESA WELLS PH.D.

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E FAIRMOUNT AVE
BALTIMORE MD
21231-1534
US

IV. Provider business mailing address

1750 E FAIRMOUNT AVE
BALTIMORE MD
21231-1534
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-4429
  • Fax:
Mailing address:
  • Phone: 443-923-4429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number04816
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number04816
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: