Provider Demographics
NPI:1053409516
Name:GLASSMAN, STEPHANIE KUNDRAT (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:KUNDRAT
Last Name:GLASSMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:LEIGH
Other - Last Name:KUNDRAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:708 MAYO RD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4660
Mailing Address - Country:US
Mailing Address - Phone:410-766-5059
Mailing Address - Fax:
Practice Address - Street 1:1223 ANNAPOLIS RD
Practice Address - Street 2:SUITE A
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1328
Practice Address - Country:US
Practice Address - Phone:443-286-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4318103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical