Healthcare Provider Details

I. General information

NPI: 1629893789
Provider Name (Legal Business Name): VALERIE LOUGHREY MA, CAS, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALERIE SIATKOWSKI MA CAS NCSP

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 LOCH RAVEN BLVD
BALTIMORE MD
21239-3522
US

IV. Provider business mailing address

5201 LOCH RAVEN BLVD
BALTIMORE MD
21239-3522
US

V. Phone/Fax

Practice location:
  • Phone: 410-960-1365
  • Fax:
Mailing address:
  • Phone: 410-989-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number34821
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: