Provider Demographics
NPI:1548204316
Name:VANDERHORST, GLORIA KAY (PHD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:KAY
Last Name:VANDERHORST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 WINNETT RD
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3265
Mailing Address - Country:US
Mailing Address - Phone:301-578-8760
Mailing Address - Fax:
Practice Address - Street 1:7910 WOODMONT AVE
Practice Address - Street 2:SUITE 1101
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3002
Practice Address - Country:US
Practice Address - Phone:301-578-8760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0980103T00000X
DCPSY1000365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS786L602Medicare UPIN