Healthcare Provider Details

I. General information

NPI: 1366740078
Provider Name (Legal Business Name): S BARBARA PERRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W CHESAPEAKE AVE
TOWSON MD
21204-4820
US

IV. Provider business mailing address

25 W CHESAPEAKE AVE
TOWSON MD
21204-4820
US

V. Phone/Fax

Practice location:
  • Phone: 410-984-3362
  • Fax: 410-339-3475
Mailing address:
  • Phone: 410-984-3362
  • Fax: 410-339-3475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number07087
License Number StateMD

VIII. Authorized Official

Name: MS. STEPHANIE BARBARA PERRY
Title or Position: LCSW-C
Credential: MSW
Phone: 410-984-3362