Provider Demographics
NPI:1881769180
Name:DELAY, TERRI S (PHD)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:S
Last Name:DELAY
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 1:204 E JOPPA ROAD
Mailing Address - Street 2:PH #16
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:410-337-9441
Mailing Address - Fax:410-339-7169
Practice Address - Street 1:204 E JOPPA ROAD
Practice Address - Street 2:PH #16
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-337-9441
Practice Address - Fax:410-339-7169
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03044103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
221819OtherCOMPSYCH
245892OtherMAMSI
6148835OtherUNITED BEHAVIORAL HEALTH
58050004OtherCAREFIRST BCBS
581M899FMedicare ID - Type Unspecified