Provider Demographics
NPI:1801099080
Name:MCBRIDE, SALLY G (PHD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:G
Last Name:MCBRIDE
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 1:1011 BAY RIDGE AVE # 119
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-3031
Mailing Address - Country:US
Mailing Address - Phone:443-223-9002
Mailing Address - Fax:
Practice Address - Street 1:1011 BAY RIDGE AVE # 119
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-3031
Practice Address - Country:US
Practice Address - Phone:443-223-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
571217260OtherTAX ID.