Provider Demographics
NPI:1356460034
Name:THORNBURGH, GAIL KRIEGER (PHD11)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:KRIEGER
Last Name:THORNBURGH
Suffix:
Gender:F
Credentials:PHD11
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 BANNOCKBURN DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-5403
Mailing Address - Country:US
Mailing Address - Phone:301-320-1573
Mailing Address - Fax:301-320-1352
Practice Address - Street 1:6319 BANNOCKBURN DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-5403
Practice Address - Country:US
Practice Address - Phone:301-320-1573
Practice Address - Fax:301-320-1352
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02592103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist