Healthcare Provider Details

I. General information

NPI: 1033073754
Provider Name (Legal Business Name): MILLERSVILLE PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 BENFIELD BLVD STE H
MILLERSVILLE MD
21108
US

IV. Provider business mailing address

1110 BENFIELD BLVD STE H
MILLERSVILLE MD
21108
US

V. Phone/Fax

Practice location:
  • Phone: 443-562-1462
  • Fax: 410-987-4710
Mailing address:
  • Phone: 443-562-1462
  • Fax: 410-987-4710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. LAWRENCE G IACARINO
Title or Position: DIRECTOR
Credential:
Phone: 443-562-1462