Provider Demographics
NPI:1821238734
Name:KETT, ALLYSON (PSYD)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:KETT
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 1:877 BALTIMORE ANNAPOLIS BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4716
Mailing Address - Country:US
Mailing Address - Phone:703-869-4053
Mailing Address - Fax:410-684-3973
Practice Address - Street 1:877 BALTIMORE ANNAPOLIS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4716
Practice Address - Country:US
Practice Address - Phone:410-684-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04712103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD04712OtherLICENSE