The Metamorphorsis Institute, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

03567 Issued in MD

Legal business name

THE METAMORPHORSIS INSTITUTE, LLC

Practice address

7131 Liberty Rd
Suite 202
Baltimore, MD 21207-4575

Phone

(443) 436-3003

Fax

(443) 436-3002

NPI assigned

Sep 16, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Mary L Taylor-Ennis, PH.D.

Title

Psychologist/Member

Phone

(443) 444-5798

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253491200000",
    "number": "1609109131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7131 LIBERTY RD",
            "address_2": "SUITE 202",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212074575",
            "telephone_number": "443-436-3003",
            "fax_number": "443-436-3002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7131 LIBERTY RD",
            "address_2": "SUITE 202",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212074575",
            "telephone_number": "443-436-3003",
            "fax_number": "443-436-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE METAMORPHORSIS INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-16",
        "last_updated": "2009-09-21",
        "status": "A",
        "authorized_official_last_name": "TAYLOR-ENNIS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PSYCHOLOGIST/MEMBER",
        "authorized_official_telephone_number": "443-444-5798",
        "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": "03567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "251502400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.