Healthcare Provider Details

I. General information

NPI: 1245214840
Provider Name (Legal Business Name): CATHERINE BISHOP OBROCEA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 MAIN ST SUITE 100
GAITHERSBURG MD
20878-6572
US

IV. Provider business mailing address

367 MAIN ST SUITE 100
GAITHERSBURG MD
20878-6572
US

V. Phone/Fax

Practice location:
  • Phone: 301-519-0904
  • Fax: 301-519-0905
Mailing address:
  • Phone: 301-519-0904
  • Fax: 301-519-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number04022
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: