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General NPI Number Information
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NPI Number | 1073449153
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Entity Type | Organization
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Legal Business Name | JERRY T. LAWLER PHD PSYCHOLOGIST LLC
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Dates
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Enumeration Date | 06/18/2026
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Last Update Date | 06/18/2026
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Provider Practice Location Address
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Address Line | 5054 DORSEY HALL DR STE 105
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-7795
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Country | US
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Telephone | 410-804-1413
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Fax |
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Provider Business Mailing Address
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Address Line | 109 W RANDALL ST
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City | BALTIMORE
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State | MD
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Zip | 21230-4431
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Country | US
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Telephone | 410-804-1413
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JERRY T. LAWLER
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Credential | PHD
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Telephone | 410-804-1413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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