Healthcare Provider Details

I. General information

NPI: 1730514357
Provider Name (Legal Business Name): MARIE DEYRO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 OLD SOLOMONS ISLAND RD
ANNAPOLIS MD
21401-3854
US

IV. Provider business mailing address

9260 RED CART CT
COLUMBIA MD
21045-4011
US

V. Phone/Fax

Practice location:
  • Phone: 908-413-3508
  • Fax:
Mailing address:
  • Phone: 908-413-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number05243
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: