Provider Demographics
NPI:1821050873
Name:NUSBAUM, ALEXIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:NUSBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:ROSENOER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:585 MAIN ST STE 143
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4354
Mailing Address - Country:US
Mailing Address - Phone:301-490-0778
Mailing Address - Fax:301-498-4663
Practice Address - Street 1:10 N GREENE ST
Practice Address - Street 2:6C-128
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:410-605-7931
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2606103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical