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General NPI Number Information
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NPI Number | 1124849773
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Entity Type | Individual
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Provider Name | STEPHANIE COLLINS MASTAL
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Gender | Female
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 2644 RIVA RD
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7427
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Country | US
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Telephone | 410-222-5321
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Fax |
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Provider Business Mailing Address
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Address Line | 3413 SWALLOWTAIL CT
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City | EDGEWATER
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State | MD
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Zip | 21037-2780
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Country | US
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Telephone | 443-223-1410
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | CER67804Y6H2X0
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License Number State | MD
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