Healthcare Provider Details

I. General information

NPI: 1437595410
Provider Name (Legal Business Name): MID-ATLANTIC PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 BERWYN HOUSE RD
COLLEGE PARK MD
20740-2474
US

IV. Provider business mailing address

9900 GREENBELT RD E-293
LANHAM MD
20706-2255
US

V. Phone/Fax

Practice location:
  • Phone: 240-297-9857
  • Fax:
Mailing address:
  • Phone: 240-297-9857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04422
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number04422
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number04422
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number04422
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number04422
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number04422
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11809
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC3000754
License Number StateDC

VIII. Authorized Official

Name: DR. CHRISTOPHER BISHOP
Title or Position: CEO/PRESIDENT
Credential: PSY.D., LCSW-C
Phone: 240-297-9857