Individual
DR. MARY L TAYLOR-ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
5601 LOCH RAVEN BLVD STE 301-A, BALTIMORE, MD 21239-2905
(443) 444-5798
Mailing address
6231 FERNWAY, BALTIMORE, MD 21212-2506
(410) 323-4582
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
84-1713024
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251502400
—
MD
Enumeration date
12/12/2006
Last updated
08/05/2008
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