=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255473799
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA JUNE PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 10/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1190 W NORTHERN PKWY APT 105A
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21210-1447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-235-7899
-----------------------------------------------------
Fax | 410-433-2288
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1190 W NORTHERN PKWY APT 105A
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21210-1447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-235-7899
-----------------------------------------------------
Fax | 410-433-2288
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 2828
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------