Provider Demographics
NPI:1508650748
Name:GISERMAN-KISS, IVY (PHD)
Entity type:Individual
Prefix:DR
First Name:IVY
Middle Name:
Last Name:GISERMAN-KISS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7737 WATER ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2557
Mailing Address - Country:US
Mailing Address - Phone:516-659-3214
Mailing Address - Fax:
Practice Address - Street 1:4785 DORSEY HALL DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7728
Practice Address - Country:US
Practice Address - Phone:443-574-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02349901103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical