Healthcare Provider Details

I. General information

NPI: 1063236735
Provider Name (Legal Business Name): SUSAN SCHARF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

200 E NORTH AVE
BALTIMORE MD
21202-4888
US

IV. Provider business mailing address

922 GLOUSTER CIR
HAMPSTEAD MD
21074-1743
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-8600
  • Fax:
Mailing address:
  • Phone: 443-520-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberCER-112372-X5B4P6
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: