Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 02149 | MD |
N | 103T00000X | Psychologist | 02149 | MD |
N | 103TA0700X | Adult Development & Aging Psychologist | 02149 | MD |
N | 103G00000X | Clinical Psychologist | 02149 | MD |
N | 103TC0700X | Clinical Psychologist | 02149 | MD |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 02149 | MD |
NPI | 1063426104 |
---|---|
Provider Name | Dr. Mariellen E North |
First Address | Dayton, MD 21036-1132 |
Second Address | Lutherville, MD 21093-6097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R95492 | (02) | MD |