Provider Demographics
NPI:1942821004
Name:WESTERN MARYLAND PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:WESTERN MARYLAND PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRAW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-800-8696
Mailing Address - Street 1:640 BASHORE DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-7606
Mailing Address - Country:US
Mailing Address - Phone:301-800-8696
Mailing Address - Fax:
Practice Address - Street 1:14407 MARSH PIKE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-1647
Practice Address - Country:US
Practice Address - Phone:301-800-8696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health