Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 06224 | MD |
NPI | 1083178578 |
---|---|
Provider Name | Kara Koenig |
First Address | Baltimore, MD 21209-4545 |
Second Address | Baltimore, MD 21208-3839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2019 |
Last Update Date | 22/11/2020 |