Healthcare Provider Details

I. General information

NPI: 1083385694
Provider Name (Legal Business Name): PATRICK KENNETH LOVE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 01/15/2022
Certification Date: 01/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4833 BETHESDA AVE STE 300
BETHESDA MD
20814-5244
US

IV. Provider business mailing address

4833 BETHESDA AVE STE 300
BETHESDA MD
20814-5244
US

V. Phone/Fax

Practice location:
  • Phone: 202-540-9945
  • Fax:
Mailing address:
  • Phone: 703-627-2267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSYA200001241
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSYA200001241
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: