Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 03207 | MD |
N | 103T00000X | Psychologist | 03207 | MD |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 03207 | MD |
Y | 103TC1900X | Counseling Psychologist | 03207 | MD |
N | 103TH0100X | Health Service | 03207 | MD |
NPI | 1467624668 |
---|---|
Provider Name | Dr. Ellen Balkam Lent |
First Address | Olney, MD 20832-1639 |
Second Address | Olney, MD 20832-1639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2008 |
Last Update Date | 02/03/2012 |