Provider Demographics
NPI:1942739834
Name:FUSION PSYCHOLOGICAL AND CONSULTING SERVICES, LLC
Entity Type:Organization
Organization Name:FUSION PSYCHOLOGICAL AND CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:410-353-3144
Mailing Address - Street 1:1298 BAY DALE DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2804
Mailing Address - Country:US
Mailing Address - Phone:410-353-3144
Mailing Address - Fax:
Practice Address - Street 1:1298 BAY DALE DR STE 211
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2815
Practice Address - Country:US
Practice Address - Phone:410-919-4904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05597103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty