Provider Demographics
NPI:1891296059
Name:GROTZ, TAYLOR MARIE
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:MARIE
Last Name:GROTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 GEORGIA AVE STE 411
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3713
Mailing Address - Country:US
Mailing Address - Phone:301-392-7075
Mailing Address - Fax:301-576-5487
Practice Address - Street 1:8701 GEORGIA AVE STE 411
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3713
Practice Address - Country:US
Practice Address - Phone:301-392-7075
Practice Address - Fax:301-576-5487
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst