Provider Demographics
NPI:1659118818
Name:MBANEFO, CATHERINE O (CRNP-PMH)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:O
Last Name:MBANEFO
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 LUKE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3797
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:723 LUKE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-3797
Practice Address - Country:US
Practice Address - Phone:443-929-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1727362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry