Healthcare Provider Details

I. General information

NPI: 1104987676
Provider Name (Legal Business Name): GAIL BLEACH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9006 WOODYARD RD
CLINTON MD
20735-4206
US

IV. Provider business mailing address

9006 WOODYARD RD
CLINTON MD
20735-4206
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-3636
  • Fax: 301-856-3633
Mailing address:
  • Phone: 301-856-3636
  • Fax: 301-856-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number00848
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: