Provider Demographics
NPI:1922411594
Name:WALD, REBECCA L (PHD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:WALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 50
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1306
Mailing Address - Country:US
Mailing Address - Phone:443-826-9858
Mailing Address - Fax:
Practice Address - Street 1:1777 REISTERSTOWN RD
Practice Address - Street 2:SUITE 50
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1306
Practice Address - Country:US
Practice Address - Phone:443-826-9858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05213103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical