=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427245992
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANJELI BOLE INSCORE PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2007
-----------------------------------------------------
Last Update Date | 05/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 S. EUTAW STREET 3RD FLOOR
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21201-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-328-4448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1520 HEATHER HILL LN
-----------------------------------------------------
City | COCKEYSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21030-1631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-622-3840
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 04464
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number | 04464
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------