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General NPI Number Information
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NPI Number | 1821123233
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Entity Type | Individual
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Provider Name | GINA WERTALIK BASEY PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2360 W JOPPA RD SUITE 318
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City | LUTHERVILLE
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State | MD
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Zip | 21093-4624
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Country | US
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Telephone | 410-825-3646
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Fax | 410-825-3649
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Provider Business Mailing Address
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Address Line | 5908 CROSS COUNTRY BLVD APT. B
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City | BALTIMORE
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State | MD
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Zip | 21215-3841
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Country | US
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Telephone | 410-466-1145
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 04201
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 04201
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 04201
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 04201
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License Number State | MD
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