Provider Demographics
NPI:1215573399
Name:BISHOP, THALIA YVETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THALIA
Middle Name:YVETTE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E NORTH AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4886
Mailing Address - Country:US
Mailing Address - Phone:240-522-9139
Mailing Address - Fax:240-308-8646
Practice Address - Street 1:10 E NORTH AVE STE 10
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4886
Practice Address - Country:US
Practice Address - Phone:240-242-9302
Practice Address - Fax:240-308-8646
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSYA00328103T00000X
MDA0130103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist