Active NPI
Mary L Taylor-Ennis, PH.D
- Psychologist
- Baltimore, MD
National Provider Identifier
1073674586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 03567
- Practice address
- 5601 Loch Raven Blvd Ste 301-a
Baltimore, MD 21239-2905 - Phone
- (443) 444-5798
- NPI assigned
- Dec 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 03567 | MD | Primary |
Addresses
Primary practice location
5601 Loch Raven Blvd Ste 301-a
Baltimore, MD 21239-2905
Mailing address
6231 Fernway
Baltimore, MD 21212-2506
Phone (410) 323-4582
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 251502400 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03567 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785715200000",
"number": "1073674586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6231 FERNWAY",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212122506",
"telephone_number": "410-323-4582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5601 LOCH RAVEN BLVD STE 301-A",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212392905",
"telephone_number": "443-444-5798"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYLOR-ENNIS",
"first_name": "MARY",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-12",
"last_updated": "2026-08-03",
"certification_date": "2026-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MD",
"license": "03567",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "251502400",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.