Provider Demographics
NPI:1083930721
Name:STEFANIE M CONSOLLA, PHD LLC
Entity Type:Organization
Organization Name:STEFANIE M CONSOLLA, PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CONSOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-525-5141
Mailing Address - Street 1:13927 FALCONCREST RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2261
Mailing Address - Country:US
Mailing Address - Phone:301-525-5141
Mailing Address - Fax:
Practice Address - Street 1:15803 CRABBS BRANCH WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-2842
Practice Address - Country:US
Practice Address - Phone:301-525-5141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04638103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty