Provider Demographics
NPI:1639320302
Name:MURTHA, TERI ANN (PMHNP, CNS- BC)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:ANN
Last Name:MURTHA
Suffix:
Gender:F
Credentials:PMHNP, CNS- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 KENILWORTH DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2312
Mailing Address - Country:US
Mailing Address - Phone:410-321-9311
Mailing Address - Fax:
Practice Address - Street 1:658 KENILWORTH DR
Practice Address - Street 2:SUITE 206
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2312
Practice Address - Country:US
Practice Address - Phone:410-321-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114531363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult