Healthcare Provider Details

I. General information

NPI: 1033935960
Provider Name (Legal Business Name): NNEKA OPARA MA, CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 GORSUCH AVE
BALTIMORE MD
21218-3777
US

IV. Provider business mailing address

200 E NORTH AVE
BALTIMORE MD
21202-4888
US

V. Phone/Fax

Practice location:
  • Phone: 443-984-2685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: