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General NPI Number Information
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NPI Number | 1164661799
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Entity Type | Organization
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Legal Business Name | EVERGREEN PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 02/19/2023
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Provider Practice Location Address
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Address Line | 5724 FALLS RD
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City | BALTIMORE
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State | MD
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Zip | 21209-3708
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Country | US
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Telephone | 410-336-5329
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Fax | 410-878-2783
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Provider Business Mailing Address
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Address Line | PO BOX 16277
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City | BALTIMORE
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State | MD
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Zip | 21210-0277
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Country | US
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Telephone | 410-336-5329
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Fax | 410-878-2783
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. PAUL PATRICK GIGGEY
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Credential | PH.D.
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Telephone | 410-336-5329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 04688
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 04688
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License Number State | MD
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