Healthcare Provider Details

I. General information

NPI: 1992529689
Provider Name (Legal Business Name): MS. STEPHANIE METZ
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

1400 ORLEANS ST
BALTIMORE MD
21231-1021
US

IV. Provider business mailing address

705 LINDA DR
CATONSVILLE MD
21228-3206
US

V. Phone/Fax

Practice location:
  • Phone: 443-642-4478
  • Fax:
Mailing address:
  • Phone: 609-214-4220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberCER49507N6R2J4
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: