Provider Demographics
NPI:1588992366
Name:CONSOLLA, STEFANIE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:MARIE
Last Name:CONSOLLA
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 1:13927 FALCONCREST RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2261
Mailing Address - Country:US
Mailing Address - Phone:301-525-5141
Mailing Address - Fax:
Practice Address - Street 1:15803 CRABBS BRANCH WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-2842
Practice Address - Country:US
Practice Address - Phone:301-525-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04638103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical