Healthcare Provider Details

I. General information

NPI: 1992485510
Provider Name (Legal Business Name): MARIAM ELIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SUDBROOK LANE SUITE F
PIKESVILLE MD
21208
US

IV. Provider business mailing address

115 SUDBROOK LANE SUITE F
PIKESVILLE MD
21208
US

V. Phone/Fax

Practice location:
  • Phone: 443-353-9547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87662
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: