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General NPI Number Information
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NPI Number | 1508650748
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Entity Type | Individual
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Provider Name | IVY GISERMAN-KISS PHD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 4785 DORSEY HALL DR
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-7728
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Country | US
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Telephone | 443-574-4405
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Fax |
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Provider Business Mailing Address
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Address Line | 7737 WATER ST
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City | FULTON
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State | MD
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Zip | 20759-2557
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Country | US
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Telephone | 516-659-3214
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 02349901
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License Number State | NY
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