Provider Demographics
NPI:1598572331
Name:AGUIRRE, SANDRA ESTEFANI (EDS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ESTEFANI
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 RACE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4412
Mailing Address - Country:US
Mailing Address - Phone:773-837-6904
Mailing Address - Fax:
Practice Address - Street 1:1900 WHITE OAK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-3846
Practice Address - Country:US
Practice Address - Phone:443-809-5238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18621103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool