Healthcare Provider Details

I. General information

NPI: 1851483788
Provider Name (Legal Business Name): MARJORIE E. OKUM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 YORK RD #39
LUTHERVILLE MD
21093-6210
US

IV. Provider business mailing address

111 HAMLET HILL RD #310
BALTIMORE MD
21210-1556
US

V. Phone/Fax

Practice location:
  • Phone: 410-323-6099
  • Fax: 410-323-6093
Mailing address:
  • Phone: 410-323-7999
  • Fax: 410-323-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0913
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0913
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0913
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number0913
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: