Provider Demographics
NPI:1114133980
Name:LOVE, BARBARA GRAYSON (PHD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:GRAYSON
Last Name:LOVE
Suffix:
Gender:F
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:PO BOX 5962
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21094-5962
Mailing Address - Country:US
Mailing Address - Phone:866-392-8858
Mailing Address - Fax:866-392-8858
Practice Address - Street 1:1110 BENFIELD BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2639
Practice Address - Country:US
Practice Address - Phone:866-392-8858
Practice Address - Fax:866-392-8858
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02672103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist