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General NPI Number Information
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NPI Number | 1528881174
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Entity Type | Individual
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Provider Name | BRENDA QUILLEN GRETZINGER PHD
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Gender | Female
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 125 N COURT ST
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City | WESTMINSTER
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State | MD
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Zip | 21157-5192
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Country | US
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Telephone | 410-751-3122
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Fax |
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Provider Business Mailing Address
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Address Line | 6627 MARVIN AVE
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City | SYKESVILLE
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State | MD
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Zip | 21784-6340
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Country | US
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Telephone | 410-206-6890
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 02948
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | CER-98028-B6Q0L0
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License Number State | MD
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