Healthcare Provider Details

I. General information

NPI: 1386762706
Provider Name (Legal Business Name): NATASHA DURANT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 KERNAN DR
BALTIMORE MD
21207-6665
US

IV. Provider business mailing address

2200 KERNAN DR
BALTIMORE MD
21207-6665
US

V. Phone/Fax

Practice location:
  • Phone: 410-448-6624
  • Fax:
Mailing address:
  • Phone: 410-448-6624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number659333
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: