Healthcare Provider Details

I. General information

NPI: 1578713863
Provider Name (Legal Business Name): DILIP DAVID PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2328 W JOPPA RD SUITE 10
LUTHERVILLE MD
21093-4612
US

IV. Provider business mailing address

2328 W JOPPA RD SUITE 10
LUTHERVILLE MD
21093-4612
US

V. Phone/Fax

Practice location:
  • Phone: 410-828-7792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number04670
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number04670
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04670
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number04670
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: