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General NPI Number Information
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NPI Number | 1801152962
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Entity Type | Organization
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Legal Business Name | PSYCHEXPERTS & ASSOCIATES
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 611 PARK AVE SUITE 102
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City | BALTIMORE
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State | MD
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Zip | 21201-4572
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Country | US
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Telephone | 410-777-8130
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Fax | 410-777-8134
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Provider Business Mailing Address
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Address Line | 611 PARK AVE SUITE 102
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City | BALTIMORE
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State | MD
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Zip | 21201-4572
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Country | US
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Telephone | 410-777-8130
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Fax | 410-777-8134
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BEVERLI MORMILE
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Credential | PSY.D.
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Telephone | 410-777-8130
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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 | 05046
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License Number State | MD
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