Provider Demographics
NPI:1114167087
Name:TARQUIN, KRISTEN M (PHD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:TARQUIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 BAY DALE DR # 333
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2325
Mailing Address - Country:US
Mailing Address - Phone:443-584-3532
Mailing Address - Fax:866-520-3465
Practice Address - Street 1:1290 BAY DALE DR # 333
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2325
Practice Address - Country:US
Practice Address - Phone:443-584-3532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04469103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical