Healthcare Provider Details

I. General information

NPI: 1063809549
Provider Name (Legal Business Name): CHESAPEAKE PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 ROCKLEDGE DR STE 500
BETHESDA MD
20817-1886
US

IV. Provider business mailing address

8607 CEDAR ST
SILVER SPRING MD
20910-4324
US

V. Phone/Fax

Practice location:
  • Phone: 301-562-8448
  • Fax: 877-250-1841
Mailing address:
  • Phone: 301-562-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN NADEAU
Title or Position: CLINICAL DIRECTOR
Credential: PHD
Phone: 301-562-8448