Healthcare Provider Details

I. General information

NPI: 1346711439
Provider Name (Legal Business Name): NATALIE GWIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PKWY STE 310
COLUMBIA MD
21044-3264
US

IV. Provider business mailing address

4810 RED FOX RD
ROCKVILLE MD
20852-2318
US

V. Phone/Fax

Practice location:
  • Phone: 240-547-9462
  • Fax:
Mailing address:
  • Phone: 240-812-1174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number05365
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: