Healthcare Provider Details

I. General information

NPI: 1265255145
Provider Name (Legal Business Name): RICK BUSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 PIONEER DR
BALTIMORE MD
21214-1092
US

IV. Provider business mailing address

1065 ALEXANDRIA WAY
BEL AIR MD
21014-2491
US

V. Phone/Fax

Practice location:
  • Phone: 410-638-7394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number30-7607
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: