Provider Demographics
NPI:1003938846
Name:CHESAPEAKE BAY PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:CHESAPEAKE BAY PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SMITHMYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-604-0226
Mailing Address - Street 1:155 LOG CANOE CIR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2127
Mailing Address - Country:US
Mailing Address - Phone:410-604-0226
Mailing Address - Fax:877-643-0126
Practice Address - Street 1:155 LOG CANOE CIR
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666
Practice Address - Country:US
Practice Address - Phone:410-604-0226
Practice Address - Fax:877-643-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03850103T00000X, 103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922164177OtherINDIVIDUAL NPI OF OWNER