Individual
DR. AMY S PROVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
630 PICCADILLY RD, TOWSON, MD 21204-3803
(443) 846-6146
Mailing address
630 PICCADILLY RD, TOWSON, MD 21204-3803
(443) 846-6146
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
04508
MD
Other
Enumeration date
01/06/2016
Last updated
01/06/2016
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