Provider Demographics
NPI:1073670733
Name:CODORI, ANN-MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANN-MARIE
Middle Name:
Last Name:CODORI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 40TH ST
Mailing Address - Street 2:SUITE 316A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2120
Mailing Address - Country:US
Mailing Address - Phone:410-235-6588
Mailing Address - Fax:410-235-4350
Practice Address - Street 1:711 W 40TH ST
Practice Address - Street 2:SUITE 316A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2120
Practice Address - Country:US
Practice Address - Phone:410-235-6588
Practice Address - Fax:410-235-4350
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDGJ70OtherOLD PROVIDER NUMBER
MDGJ70OtherOLD PROVIDER NUMBER