Healthcare Provider Details

I. General information

NPI: 1942821004
Provider Name (Legal Business Name): WESTERN MARYLAND PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14407 MARSH PIKE
HAGERSTOWN MD
21742-1647
US

IV. Provider business mailing address

640 BASHORE DR
MARTINSBURG WV
25404-7606
US

V. Phone/Fax

Practice location:
  • Phone: 301-800-8696
  • Fax:
Mailing address:
  • Phone: 301-800-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE MCGRAW
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 301-800-8696