Provider Demographics
NPI:1518089648
Name:SHOCKLEY, TAMRA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TAMRA
Middle Name:A
Last Name:SHOCKLEY
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 1:120 SISTER PIERRE DRIVE
Mailing Address - Street 2:SUITE 107, PROFESSIONAL CENTRE
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-337-9441
Mailing Address - Fax:410-339-7169
Practice Address - Street 1:120 SISTER PIERRE DRIVE
Practice Address - Street 2:SUITE 107, PROFESSIONAL CENTRE
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-337-9441
Practice Address - Fax:410-339-7169
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04640103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical