Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | ZZ |
NPI | 1134418429 |
---|---|
Provider Name | Dr. Keenan Kester Cofield |
First Address | Baltimore, MD 21237-3550 |
Second Address | Baltimore, MD 21234-4924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2011 |
Last Update Date | 07/04/2011 |