Provider Demographics
NPI:1932590197
Name:NUSSBAUM, SERACH (MCD)
Entity type:Individual
Prefix:
First Name:SERACH
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1302
Mailing Address - Country:US
Mailing Address - Phone:410-887-1714
Mailing Address - Fax:
Practice Address - Street 1:701 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1302
Practice Address - Country:US
Practice Address - Phone:410-887-1714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC271648235Z00000X
MD09282235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist