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General NPI Number Information
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NPI Number | 1053409516
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Entity Type | Individual
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Provider Name | STEPHANIE KUNDRAT GLASSMAN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1223 ANNAPOLIS RD SUITE A
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City | ODENTON
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State | MD
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Zip | 21113-1328
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Country | US
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Telephone | 443-286-0417
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Fax |
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Provider Business Mailing Address
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Address Line | 708 MAYO RD
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City | GLEN BURNIE
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State | MD
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Zip | 21061-4660
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Country | US
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Telephone | 410-766-5059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4318
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License Number State | MD
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