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General NPI Number Information
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NPI Number | 1992815385
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Entity Type | Organization
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Legal Business Name | C & L THERAPIES, INC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | 8415 BELLONA LN SUITE 107
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City | BALTIMORE
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State | MD
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Zip | 21204-2055
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Country | US
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Telephone | 443-668-6942
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Fax | 410-285-0560
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Provider Business Mailing Address
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Address Line | 8415 BELLONA LN SUITE 107
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City | BALTIMORE
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State | MD
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Zip | 21204-2055
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Country | US
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Telephone | 443-668-6942
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Fax | 410-285-0560
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. COLLEEN SPADA
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Credential | PSYD
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Telephone | 443-668-6942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 04110
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License Number State | MD
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