Provider Demographics
NPI:1629108022
Name:LEPORE, JANICE CHRISTINE COLLEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:CHRISTINE COLLEEN
Last Name:LEPORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 FRONT AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5365
Mailing Address - Country:US
Mailing Address - Phone:443-912-1230
Mailing Address - Fax:
Practice Address - Street 1:1400 FRONT AVE STE 204
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5365
Practice Address - Country:US
Practice Address - Phone:443-912-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04196103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical