Healthcare Provider Details

I. General information

NPI: 1053409516
Provider Name (Legal Business Name): STEPHANIE K GLASSMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE LEIGH KUNDRAT M.A.

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 WILLOW BEND DR
GLEN BURNIE MD
21060-8495
US

IV. Provider business mailing address

461 WILLOW BEND DR
GLEN BURNIE MD
21060-8495
US

V. Phone/Fax

Practice location:
  • Phone: 443-286-0417
  • Fax: 443-927-8782
Mailing address:
  • Phone: 443-286-0417
  • Fax: 443-927-8782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4318
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: