Healthcare Provider Details

I. General information

NPI: 1487591822
Provider Name (Legal Business Name): RAE UNDERBERG PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S MAIN ST
HURLOCK MD
21643-3508
US

IV. Provider business mailing address

PO BOX 39
HURLOCK MD
21643-0039
US

V. Phone/Fax

Practice location:
  • Phone: 410-449-0033
  • Fax:
Mailing address:
  • Phone: 410-449-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number07402
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: