Provider Demographics
NPI:1881483519
Name:M OWENS, DEATRA MARIE
Entity type:Individual
Prefix:
First Name:DEATRA
Middle Name:MARIE
Last Name:M OWENS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 EIERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-6315
Mailing Address - Country:US
Mailing Address - Phone:443-983-2906
Mailing Address - Fax:
Practice Address - Street 1:4020 EIERMAN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-6315
Practice Address - Country:US
Practice Address - Phone:443-983-2906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service