| NPI | 1952105751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY MALLARE Nurse Practitioner 410-718-3213 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-04-02 |
| Last Update Date | 2026-06-05 |