Provider Demographics
NPI:1801152954
Name:MORMILE, BEVERLI B (PSYD)
Entity type:Individual
Prefix:DR
First Name:BEVERLI
Middle Name:B
Last Name:MORMILE
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 1:5707 CALVERTON ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1780
Mailing Address - Country:US
Mailing Address - Phone:443-743-0103
Mailing Address - Fax:
Practice Address - Street 1:10 SOUTH ST STE 303
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3288
Practice Address - Country:US
Practice Address - Phone:443-743-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05046103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic