Healthcare Provider Details

I. General information

NPI: 1992054324
Provider Name (Legal Business Name): LILIAN ODERA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8258 VETERANS HWY STE 13-15
MILLERSVILLE MD
21108-1457
US

IV. Provider business mailing address

8258 VETERANS HWY STE 13-15
MILLERSVILLE MD
21108-1457
US

V. Phone/Fax

Practice location:
  • Phone: 410-757-2077
  • Fax:
Mailing address:
  • Phone: 410-757-2077
  • Fax: 443-782-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number05769
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: