Provider Demographics
NPI:1083385694
Name:LOVE, PATRICK KENNETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:KENNETH
Last Name:LOVE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 BETHESDA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5244
Mailing Address - Country:US
Mailing Address - Phone:703-627-2267
Mailing Address - Fax:
Practice Address - Street 1:4833 BETHESDA AVE STE 300
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5244
Practice Address - Country:US
Practice Address - Phone:202-540-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSYA200001241103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPSYA200001241OtherWASHINGTON DC PSYCHOLOGICAL ASSOCIATE LICENSE