Stefanie M Consolla, PHD LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

04638 Issued in MD

Legal business name

STEFANIE M CONSOLLA, PHD LLC

Practice address

15803 Crabbs Branch Way
2ND Floor
Derwood, MD 20855-2842

Phone

(301) 525-5141

NPI assigned

Apr 19, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Stefanie Marie Consolla, PH.D.NPI 1588992366

Title

Clinical Psychologist

Phone

(301) 525-5141

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stefanie Marie Consolla, PH.D.

  • Clinical Psychologist
  • Derwood, MD
  • NPI 1588992366

  DC

  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430870400000",
    "number": "1083930721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13927 FALCONCREST RD",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208742261",
            "telephone_number": "301-525-5141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15803 CRABBS BRANCH WAY",
            "address_2": "2ND FLOOR",
            "city": "DERWOOD",
            "state": "MD",
            "postal_code": "208552842",
            "telephone_number": "301-525-5141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEFANIE M CONSOLLA, PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-19",
        "last_updated": "2015-05-06",
        "status": "A",
        "authorized_official_last_name": "CONSOLLA",
        "authorized_official_first_name": "STEFANIE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "301-525-5141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "04638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Derwood, MD
• Providers in Derwood, MD by specialty
• Clinical Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.