Individual
DR. JASON M PRENOVEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4501 N CHARLES ST, BALTIMORE, MD 21210-2601
(410) 617-5240
Mailing address
112 BRANDON RD, BALTIMORE, MD 21212-1127
(410) 337-0523
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
05005
MD
Other
Enumeration date
06/09/2017
Last updated
06/09/2017
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