Individual
STEPHEN WEGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2905
(410) 532-4701
Mailing address
PO BOX 64407, BALTIMORE, MD 21264-4407
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
03173
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
338130700
—
MD
Enumeration date
06/11/2006
Last updated
04/10/2014
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