Provider Demographics
NPI:1164661799
Name:EVERGREEN PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:EVERGREEN PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GIGGEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-336-5329
Mailing Address - Street 1:PO BOX 16277
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-0277
Mailing Address - Country:US
Mailing Address - Phone:410-336-5329
Mailing Address - Fax:410-878-2783
Practice Address - Street 1:5724 FALLS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3708
Practice Address - Country:US
Practice Address - Phone:410-336-5329
Practice Address - Fax:410-878-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04688103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty