1942384185 NPI number — DR. LARAY IMANI PRICE PH.D. - PSYCHOLOGIST

Table of content: DR. LARAY IMANI PRICE PH.D. - PSYCHOLOGIST (NPI 1942384185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942384185 NPI number — DR. LARAY IMANI PRICE PH.D. - PSYCHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
LARAY
Provider Middle Name:
IMANI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D. - PSYCHOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRICE-ABDELRAZZAQ
Provider Other First Name:
LARAY
Provider Other Middle Name:
IMANI
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D. - PSYCHOLOGIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942384185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
331 GAMBRILLS RD STE 4B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAMBRILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21054-1141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-569-8882
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 GAMBRILLS RD STE 4B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAMBRILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21054-1141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-569-8882
Provider Business Practice Location Address Fax Number:
410-697-3623
Provider Enumeration Date:
10/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: PSY1001307 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 05442 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 05442 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07944490 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".