MEDICARE: DR. DANIELLE MARIE PLOETZ PH.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
1	101YM0800X	Mental Health Counselor
2	103G00000X	Clinical Neuropsychologist	05595	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669660999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE MARIE PLOETZ PH.D.

Provider Business Mailing Address
First Line	:	707 N BROADWAY
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21205-1832
Country	:	US
Telephone Number	:	443-923-1872
Fax Number	:

Provider Business Practice Location Address
First Line	:	2931 E BIDDLE ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21213-3939
Country	:	US
Telephone Number	:	443-923-1872
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	09/24/2015

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