Healthcare Provider Details

I. General information

NPI: 1528154358
Provider Name (Legal Business Name): DOROTHY A TRACEY RUSIN PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20001 BUCKLODGE RD
BOYDS MD
20841-9600
US

IV. Provider business mailing address

20001 BUCKLODGE RD
BOYDS MD
20841-9600
US

V. Phone/Fax

Practice location:
  • Phone: 240-731-7431
  • Fax:
Mailing address:
  • Phone: 240-731-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number925
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: