Provider Demographics
NPI:1164620134
Name:PHARUNS-BAPTISTE, GUIRLA J (C O T A)
Entity Type:Individual
Prefix:MRS
First Name:GUIRLA
Middle Name:J
Last Name:PHARUNS-BAPTISTE
Suffix:
Gender:F
Credentials:C O T A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SCOTTSBURY CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6014
Mailing Address - Country:US
Mailing Address - Phone:240-427-2812
Mailing Address - Fax:301-540-9444
Practice Address - Street 1:9 SCOTTSBURY CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-6014
Practice Address - Country:US
Practice Address - Phone:240-427-2812
Practice Address - Fax:301-540-9444
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00530171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDOO530OtherMARYLAND MENTAL HEALTHAND