NPIMap

Organization Active NPI

Core Clinical Services

  • Clinical Psychologist
  • Timonium, MD
National Provider Identifier
1649656943
Registry record updated Aug 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
05420 Issued in MD
Legal business name
CORE CLINICAL SERVICES
Practice address
9475 Deereco Rd
Suite 410
Timonium, MD 21093-2118
Phone
(410) 560-6135
Fax
(410) 560-6136
NPI assigned
Aug 10, 2015
Last updated
Aug 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2023

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

Authorized official

Name
Dr. Marquerite Petranella Laban, PHDNPI 1659472090
Title
Owner
Phone
(410) 371-7187

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 05420 MD Primary

Addresses

Primary practice location

9475 Deereco Rd
Suite 410
Timonium, MD 21093-2118

Mailing address

9475 Deereco Rd
Suite 410
Timonium, MD 21093-2118
Phone (410) 560-6135

Other identifiers 1

IdentifierTypeStateIssuer
717002500MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171127000746 MD Part B Supplier - Clinic/Group Practice 8123385333 Receives reassigned benefits from 1 practitioner
Practice locations: Timonium, MD

National Provider Directory

National Provider Directory

Locations

9475 Deereco Rd
Timonium, MD 21093
Phone (410) 308-3543

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1439164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691452800000",
    "number": "1649656943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9475 DEERECO RD",
            "address_2": "SUITE 410",
            "city": "TIMONIUM",
            "state": "MD",
            "postal_code": "210932118",
            "telephone_number": "410-560-6135",
            "fax_number": "410-560-6136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9475 DEERECO RD",
            "address_2": "SUITE 410",
            "city": "TIMONIUM",
            "state": "MD",
            "postal_code": "210932118",
            "telephone_number": "410-560-6135",
            "fax_number": "410-560-6136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORE CLINICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-10",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A",
        "authorized_official_last_name": "LABAN",
        "authorized_official_first_name": "MARQUERITE",
        "authorized_official_middle_name": "PETRANELLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-371-7187",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "05420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "717002500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Timonium, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; 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.