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General NPI Number Information
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NPI Number | 1609109131
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Entity Type | Organization
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Legal Business Name | THE METAMORPHORSIS INSTITUTE, LLC
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 7131 LIBERTY RD SUITE 202
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City | BALTIMORE
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State | MD
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Zip | 21207-4575
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Country | US
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Telephone | 443-436-3003
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Fax | 443-436-3002
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Provider Business Mailing Address
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Address Line | 7131 LIBERTY RD SUITE 202
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City | BALTIMORE
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State | MD
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Zip | 21207-4575
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Country | US
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Telephone | 443-436-3003
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Fax | 443-436-3002
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Authorized Official
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Title or Position | PSYCHOLOGIST/MEMBER
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Name | DR. MARY L TAYLOR-ENNIS
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Credential | PH.D.
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Telephone | 443-444-5798
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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 | 03567
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License Number State | MD
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