Healthcare Provider Details

I. General information

NPI: 1922078021
Provider Name (Legal Business Name): MARIA NMI MOURATIDIS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 SAINT JOHNS LN STE F
ELLICOTT CITY MD
21042-2600
US

IV. Provider business mailing address

3355 SAINT JOHNS LN STE F
ELLICOTT CITY MD
21042-2600
US

V. Phone/Fax

Practice location:
  • Phone: 443-545-6530
  • Fax:
Mailing address:
  • Phone: 443-545-6530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04187
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: