Healthcare Provider Details

I. General information

NPI: 1205494200
Provider Name (Legal Business Name): OPHIRA WEISKOPF PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 W ROGERS AVE
BALTIMORE MD
21215-4525
US

IV. Provider business mailing address

6119 WESTERN RUN DR
BALTIMORE MD
21209-3816
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-0567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04914
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: