Healthcare Provider Details

I. General information

NPI: 1215653597
Provider Name (Legal Business Name): CARLEY M ENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 E FORT AVE
BALTIMORE MD
21230-5215
US

IV. Provider business mailing address

2 E JOPPA RD APT 203
TOWSON MD
21286-3142
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-1503
  • Fax:
Mailing address:
  • Phone: 732-768-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number02438L
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: