| Stefanie M Consolla, Phd Llc | |
|
15803 Crabbs Branch Way 2nd Floor Derwood MD 20855-2842 | |
| (301) 525-5141 | |
| Not Available |
| Full Name | Stefanie M Consolla, Phd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 15803 Crabbs Branch Way, Derwood, Maryland |
| Authorized Official Name and Position | Stefanie Marie Consolla (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 3015255141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stefanie M Consolla, Phd Llc 13927 Falconcrest Rd Germantown MD 20874-2261 Ph: (301) 525-5141 | Stefanie M Consolla, Phd Llc 15803 Crabbs Branch Way 2nd Floor Derwood MD 20855-2842 Ph: (301) 525-5141 |
| NPI Number | 1083930721 |
|---|---|
| Provider Enumeration Date | 04/19/2010 |
| Last Update Date | 05/06/2015 |
| Medicare PECOS PAC ID | 9931238284 |
|---|---|
| Medicare Enrollment ID | O20100525000155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083930721 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 04638 (Maryland) | Primary |
| Provider Name | Stefanie M Consolla |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588992366 PECOS PAC ID: 8022145705 Enrollment ID: I20100525000309 |
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