=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346790466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMPATHKARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2016
-----------------------------------------------------
Last Update Date | 10/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2408 SMITH AVE
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21209-2634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-768-6095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2408 SMITH AVE
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21209-2634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-768-6095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | GRACE EKPENYONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-768-6095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------