Healthcare Provider Details

I. General information

NPI: 1073449153
Provider Name (Legal Business Name): JERRY T. LAWLER PHD PSYCHOLOGIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5054 DORSEY HALL DR STE 105
ELLICOTT CITY MD
21042-7795
US

IV. Provider business mailing address

109 W RANDALL ST
BALTIMORE MD
21230-4431
US

V. Phone/Fax

Practice location:
  • Phone: 410-804-1413
  • Fax:
Mailing address:
  • Phone: 410-804-1413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY T. LAWLER
Title or Position: OWNER
Credential: PHD
Phone: 410-804-1413