MEDICARE: DR. SABINA F CORONADO 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
1	103TC0700X	Clinical Psychologist	03625	MD

General Provider Information

NPI Number	:	1669687109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SABINA F CORONADO PSY.D.

Provider Business Mailing Address
First Line	:	3450 FORT MEADE RD
Second Line	:	SUITE 110
City	:	LAUREL
State	:	MD
Zip	:	20724-2040
Country	:	US
Telephone Number	:	301-317-8100
Fax Number	:	301-317-0118

Provider Business Practice Location Address
First Line	:	3450 FORT MEADE RD
Second Line	:	SUITE 110
City	:	LAUREL
State	:	MD
Zip	:	20724-2040
Country	:	US
Telephone Number	:	301-317-8100
Fax Number	:	301-317-0118

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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