Provider Demographics
NPI:1497091102
Name:KIDD, MALINDA RENEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MALINDA
Middle Name:RENEE
Last Name:KIDD
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 1:9412 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3049
Mailing Address - Country:US
Mailing Address - Phone:301-275-6737
Mailing Address - Fax:
Practice Address - Street 1:9412 FOX RUN DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3049
Practice Address - Country:US
Practice Address - Phone:301-275-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD061225100Medicaid