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General NPI Number Information
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NPI Number | 1972334118
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Entity Type | Individual
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Provider Name | MIRACLE MAPP M.A., C.A.S. , NCSP
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Gender | Female
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 2644 RIVA RD
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7427
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Country | US
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Telephone | 410-222-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 7900 ERIN MICHELE PKWY APT 240
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City | SEVERN
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State | MD
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Zip | 21144-1268
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Country | US
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Telephone | 410-845-8329
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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 | 15718
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License Number State | MD
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