Healthcare Provider Details

I. General information

NPI: 1649588054
Provider Name (Legal Business Name): VANESSA RAMOS SCARBOROUGH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FILA WAY STE 201A
SPARKS MD
21152-9454
US

IV. Provider business mailing address

10 FILA WAY STE 201A
SPARKS MD
21152-9454
US

V. Phone/Fax

Practice location:
  • Phone: 410-343-9704
  • Fax:
Mailing address:
  • Phone: 410-343-9704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number04876
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY9829
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: