Organization
THE METAMORPHORSIS INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY L TAYLOR-ENNIS PH.D. (PSYCHOLOGIST/MEMBER)
(443) 444-5798
Entity
Organization
Contact information
Practice address
7131 LIBERTY RD, SUITE 202, BALTIMORE, MD 21207-4575
(443) 436-3003
(443) 436-3002
Mailing address
7131 LIBERTY RD, SUITE 202, BALTIMORE, MD 21207-4575
(443) 436-3003
(443) 436-3002
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
03567
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251502400
—
MD
Enumeration date
09/16/2009
Last updated
09/21/2009
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