Provider Demographics
NPI:1366891806
Name:FENTON, JAIME M (PHD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:M
Last Name:FENTON
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 1:312 W CHESAPEAKE AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4410
Mailing Address - Country:US
Mailing Address - Phone:443-602-6426
Mailing Address - Fax:
Practice Address - Street 1:312 W CHESAPEAKE AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4410
Practice Address - Country:US
Practice Address - Phone:443-602-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4435103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling