Healthcare Provider Details

I. General information

NPI: 1477289445
Provider Name (Legal Business Name): TONI MARIE REPA MS, EDS, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONI MARIE BADURA MS, EDS, NCSP

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29649 MEADOW GATE DR
EASTON MD
21601-7911
US

IV. Provider business mailing address

29649 MEADOW GATE DR
EASTON MD
21601-7911
US

V. Phone/Fax

Practice location:
  • Phone: 717-364-4981
  • Fax:
Mailing address:
  • Phone: 717-364-4981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: