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General NPI Number Information
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NPI Number | 1083930721
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Entity Type | Organization
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Legal Business Name | STEFANIE M CONSOLLA, PHD LLC
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 15803 CRABBS BRANCH WAY 2ND FLOOR
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City | DERWOOD
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State | MD
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Zip | 20855-2842
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Country | US
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Telephone | 301-525-5141
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Fax |
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Provider Business Mailing Address
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Address Line | 13927 FALCONCREST RD
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City | GERMANTOWN
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State | MD
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Zip | 20874-2261
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Country | US
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Telephone | 301-525-5141
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. STEFANIE MARIE CONSOLLA
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Credential | PH.D.
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Telephone | 301-525-5141
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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 | 04638
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License Number State | MD
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