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General NPI Number Information
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NPI Number | 1750424081
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Entity Type | Organization
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Legal Business Name | MARYLAND PSYCHOTHERAPY SERVICES LLC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 104 CHURCH LANE SUITE 206
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City | BALTIMORE
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State | MD
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Zip | 21208-3845
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Country | US
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Telephone | 410-580-0244
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Fax | 410-630-1008
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Provider Business Mailing Address
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Address Line | 104 CHURCH LANE SUITE 206
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City | BALTIMORE
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State | MD
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Zip | 21208-3845
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Country | US
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Telephone | 410-580-0244
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Fax | 410-630-1008
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Authorized Official
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Title or Position | OWNER
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Name | MS. DANICA LEE GUTTMAN
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Credential | LCSW-C, BCD
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Telephone | 410-580-0244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10308
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License Number State | MD
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