Healthcare Provider Details

I. General information

NPI: 1861220014
Provider Name (Legal Business Name): PETER MACIVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 N LAKEWOOD AVE
BALTIMORE MD
21224-1143
US

IV. Provider business mailing address

156 N LAKEWOOD AVE
BALTIMORE MD
21224-1143
US

V. Phone/Fax

Practice location:
  • Phone: 443-421-5919
  • Fax:
Mailing address:
  • Phone: 443-421-5919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number07663
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: