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General NPI Number Information
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NPI Number | 1588855662
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Entity Type | Organization
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Legal Business Name | PATRICIA J LACKEY PHD PA
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 2801 FOSTER AVENUE
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City | BALTIMORE
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State | MD
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Zip | 21224-3816
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Country | US
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Telephone | 410-499-7792
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Fax | 410-732-7427
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Provider Business Mailing Address
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Address Line | 13801 YORK RD K14
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City | COCKEYSVILLE
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State | MD
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Zip | 21030-1895
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Country | US
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Telephone | 410-499-7792
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Fax | 410-732-7427
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Authorized Official
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Title or Position | PSYCHOLOGIST PRESIDENT
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Name | DR. PATRICIA J LACKEY
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Credential | PHD
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Telephone | 410-499-7792
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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 | 03096
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License Number State | MD
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