Provider Demographics
NPI:1144234477
Name:GUMP, LARNEY R (PH D)
Entity Type:Individual
Prefix:
First Name:LARNEY
Middle Name:R
Last Name:GUMP
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 PROGRESS WAY
Mailing Address - Street 2:# 101
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784
Mailing Address - Country:US
Mailing Address - Phone:410-549-5181
Mailing Address - Fax:410-549-5182
Practice Address - Street 1:1380 PROGRESS WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784
Practice Address - Country:US
Practice Address - Phone:410-549-5181
Practice Address - Fax:410-549-5182
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00487103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD669L92QQMedicare ID - Type Unspecified