Healthcare Provider Details

I. General information

NPI: 1801768999
Provider Name (Legal Business Name): LAURA SMITH-GROSE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 CLARKSVILLE PIKE
ELLICOTT CITY MD
21042-6106
US

IV. Provider business mailing address

10910 CLARKSVILLE PIKE
ELLICOTT CITY MD
21042-6106
US

V. Phone/Fax

Practice location:
  • Phone: 410-313-6773
  • Fax:
Mailing address:
  • Phone: 410-313-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number145707N1D5M1
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: