Healthcare Provider Details

I. General information

NPI: 1487082103
Provider Name (Legal Business Name): MEREDITH MERTENS HEGEDUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MAITLAND ST
BEL AIR MD
21014-3923
US

IV. Provider business mailing address

314 MAITLAND ST
BEL AIR MD
21014-3923
US

V. Phone/Fax

Practice location:
  • Phone: 443-356-6828
  • Fax:
Mailing address:
  • Phone: 443-356-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC6432
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: