Healthcare Provider Details

I. General information

NPI: 1255807160
Provider Name (Legal Business Name): CECILIA MARIETTA PARKER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 FALLS RD
BALTIMORE MD
21209-4914
US

IV. Provider business mailing address

4623 FALLS RD
BALTIMORE MD
21209-4914
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-1980
  • Fax: 410-366-8530
Mailing address:
  • Phone: 410-366-1980
  • Fax: 410-366-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR183414
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: