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NPI Code Detail

MEDICARE: DR. THERESA ANNE CARPENTER PSY.D.

MEDICARE:  DR. THERESA ANNE CARPENTER  PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist04543MD

General Provider Information

NPI Number : 1548488828
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THERESA ANNE CARPENTER PSY.D.
Provider Business Mailing Address
First Line : 6501 NORTH CHARLES STREET
Second Line : MANN RESIDENTIAL PROGRAMS
City : BALTIMORE
State : MD
Zip : 21285
Country : US
Telephone Number : 410-938-4933
Fax Number :
Provider Business Practice Location Address
First Line : 6501 NORTH CHARLES STREET
Second Line :
City : BALTIMORE
State : MD
Zip : 21285
Country : US
Telephone Number : 410-938-4933
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2007
Last Update Date : 06/03/2009

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