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General NPI Number Information
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NPI Number | 1700274636
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Entity Type | Organization
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Legal Business Name | KING FARM PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 1831 FOREST DR STE B
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City | ANNAPOLIS
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State | MD
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Zip | 21401-4430
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Country | US
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Telephone | 202-421-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 14883 MICHELE DR
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City | GLENELG
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State | MD
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Zip | 21737-9416
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Country | US
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Telephone | 202-421-3366
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. ADAM D KLEIN
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Credential | PH.D.
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Telephone | 202-421-3366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3652
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License Number State | MD
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