Provider Demographics
NPI:1942384185
Name:PRICE, LARAY IMANI (PHD - PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:LARAY
Middle Name:IMANI
Last Name:PRICE
Suffix:
Gender:F
Credentials:PHD - PSYCHOLOGIST
Other - Prefix:DR
Other - First Name:LARAY
Other - Middle Name:IMANI
Other - Last Name:PRICE-ABDELRAZZAQ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD - PSYCHOLOGIST
Mailing Address - Street 1:331 GAMBRILLS RD STE 4B
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1141
Mailing Address - Country:US
Mailing Address - Phone:443-569-8882
Mailing Address - Fax:
Practice Address - Street 1:331 GAMBRILLS RD STE 4B
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1141
Practice Address - Country:US
Practice Address - Phone:443-569-8882
Practice Address - Fax:410-697-3623
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 225XM0800X, 1041C0700X, 225XP0200X
DCPSY1001307103T00000X
MD05442103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD07944490Medicaid
MD360156ZA4BMedicare UPIN