Healthcare Provider Details

I. General information

NPI: 1417719352
Provider Name (Legal Business Name): LINE-CYNTHIA DUCLEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GREENWOOD PL
PIKESVILLE MD
21208-2762
US

IV. Provider business mailing address

11232 LEGATO WAY
SILVER SPRING MD
20901-5049
US

V. Phone/Fax

Practice location:
  • Phone: 410-824-1333
  • Fax:
Mailing address:
  • Phone: 240-318-4302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR247114
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: