Healthcare Provider Details

I. General information

NPI: 1295243657
Provider Name (Legal Business Name): CARON MARIE CASCIATO PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 JOH AVE STE 180
HALETHORPE MD
21227-1135
US

IV. Provider business mailing address

1502 JOH AVE STE 180
HALETHORPE MD
21227-1135
US

V. Phone/Fax

Practice location:
  • Phone: 443-800-0470
  • Fax: 888-760-4333
Mailing address:
  • Phone: 443-800-0470
  • Fax: 888-760-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number05251
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: