MEDICARE: ALLYSON KETT PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	04712	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04712	OTHER	MD	LICENSE

General Provider Information

NPI Number	:	1821238734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON KETT PSYD

Provider Business Mailing Address
First Line	:	877 BALTIMORE ANNAPOLIS BLVD STE 202
Second Line	:
City	:	SEVERNA PARK
State	:	MD
Zip	:	21146-4716
Country	:	US
Telephone Number	:	703-869-4053
Fax Number	:	410-684-3973

Provider Business Practice Location Address
First Line	:	877 BALTIMORE ANNAPOLIS BLVD STE 202
Second Line	:
City	:	SEVERNA PARK
State	:	MD
Zip	:	21146-4716
Country	:	US
Telephone Number	:	410-684-3806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	02/16/2023

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Directions to “ ALLYSON KETT PSYD” Practice Location

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