Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 04571 | MD |
NPI | 1235499690 |
---|---|
Provider Name | Dr. Melissa Mae Blanock |
First Address | Catonsville, MD 21228-4724 |
Second Address | Catonsville, MD 21228-4724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2012 |
Last Update Date | 19/05/2012 |