Healthcare Provider Details

I. General information

NPI: 1043274285
Provider Name (Legal Business Name): JOE S RAINEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 08/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17201 QUAKER LANE #QL-101
SANDY SPRING MD
20860-1224
US

IV. Provider business mailing address

17201 QUAKER LANE #QL-101
SANDY SPRING MD
20860-1224
US

V. Phone/Fax

Practice location:
  • Phone: 703-343-0368
  • Fax: 703-506-4639
Mailing address:
  • Phone: 703-343-0368
  • Fax: 703-506-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01647
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: