Healthcare Provider Details

I. General information

NPI: 1972624179
Provider Name (Legal Business Name): CHRISTOPHER L BISHOP PSY.D., LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 BERWYN HOUSE RD 206
COLLEGE PARK MD
20740-2474
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 240-297-9857
  • Fax: 240-542-4356
Mailing address:
  • Phone: 240-297-9857
  • Fax: 240-542-4356

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:
Title or Position:
Credential:
Phone: