Provider Demographics
NPI:1124039268
Name:OLIVER, EDWIN C (PSY D)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:C
Last Name:OLIVER
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 NORTH RIDGE ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043
Mailing Address - Country:US
Mailing Address - Phone:410-561-9584
Mailing Address - Fax:410-750-3330
Practice Address - Street 1:2220 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5805
Practice Address - Country:US
Practice Address - Phone:410-261-5500
Practice Address - Fax:410-366-7680
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3777103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical