Healthcare Provider Details

I. General information

NPI: 1356961866
Provider Name (Legal Business Name): TERRY LEVINE GOLANER M.S., L.G.P.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 TRAVERTINE DR UNIT 206
BALTIMORE MD
21209-3847
US

IV. Provider business mailing address

8505 STEVENSON RD
PIKESVILLE MD
21208-1606
US

V. Phone/Fax

Practice location:
  • Phone: 443-690-3969
  • Fax:
Mailing address:
  • Phone: 443-690-3969
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP11626
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: