Provider Demographics
NPI:1376920504
Name:SEVERNA PARK CHILD PSYCHOLOGY
Entity Type:Organization
Organization Name:SEVERNA PARK CHILD PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:443-440-2897
Mailing Address - Street 1:485 RITCHIE HWY
Mailing Address - Street 2:SUITE 203D
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2918
Mailing Address - Country:US
Mailing Address - Phone:443-440-2897
Mailing Address - Fax:
Practice Address - Street 1:485 RITCHIE HWY
Practice Address - Street 2:SUITE 203D
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2918
Practice Address - Country:US
Practice Address - Phone:443-440-2897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04803261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health