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General NPI Number Information
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NPI Number | 1417764481
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Entity Type | Organization
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Legal Business Name | DR STEVE LLC SKILL TREE
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 1216 N MAIN ST FRNT
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City | HAMPSTEAD
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State | MD
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Zip | 21074-2256
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Country | US
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Telephone | 443-900-3999
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Fax |
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Provider Business Mailing Address
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Address Line | 4272 BUCKSKIN TRL
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City | HAMPSTEAD
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State | MD
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Zip | 21074-3102
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Country | US
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Telephone | 443-677-1639
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Fax |
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | TASHA LYNN DELLA VECCHIA
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Credential |
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Telephone | 443-677-1639
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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 |
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License Number State |
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