Healthcare Provider Details

I. General information

NPI: 1457975542
Provider Name (Legal Business Name): DINA WIECZYNSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date: 11/06/2020
Reactivation Date: 06/05/2026

III. Provider practice location address

10045 BALTIMORE NATIONAL PIKE UNIT A7; #545
ELLICOTT CITY MD
21042
US

IV. Provider business mailing address

10045 BALTIMORE NATIONAL PIKE UNIT A7; #545
ELLICOTT CITY MD
21042
US

V. Phone/Fax

Practice location:
  • Phone: 443-494-9754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: