Healthcare Provider Details

I. General information

NPI: 1154277119
Provider Name (Legal Business Name): MS. MERCEDES PETERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4998 DORSEY HALL DR UNIT A5
ELLICOTT CITY MD
21042-7729
US

IV. Provider business mailing address

4998 DORSEY HALL DR UNIT A5
ELLICOTT CITY MD
21042-7729
US

V. Phone/Fax

Practice location:
  • Phone: 240-328-9935
  • Fax:
Mailing address:
  • Phone: 240-328-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP9022
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: