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General NPI Number Information
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NPI Number | 1639998107
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Entity Type | Individual
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Provider Name | KRISTINE MARIE VAN EMBURGH NCSP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 910 N EAST RD
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City | NORTH EAST
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State | MD
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Zip | 21901-1903
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Country | US
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Telephone | 410-996-6230
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Fax |
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Provider Business Mailing Address
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Address Line | 726 STANFORD CT
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City | EDGEWOOD
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State | MD
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Zip | 21040-2111
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Country | US
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Telephone | 732-570-5890
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | MD
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