Organization Name: | STEFANIE M CONSOLLA, PHD LLC |
NPI Number: | 1083930721 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEFANIE MARIE CONSOLLA (CLINICAL PSYCHOLOGIST) |
Mailing Address: | 15803 Crabbs Branch Way 2nd Floor Derwood |
State: | MD US |
Postal Code: | 208552842 |
Phone Number: | 3015255141 |
Fax Number: | |
NPI Enumeration Date: | 04/19/2010 |
NPI Last Update Date: | 05/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 04638 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |