South River Psychiatry

LBN: South River Psychiatric Services, Llc
South River Psychiatry is an health care organization with primary practice located at 1600 Crain Hwy S Ste 608 , Glen Burnie MD 21061-6442. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as the primary health care specialty. South River Psychiatric Services, Llc can be contacted via phone (410) 205-9205, or through Ticknor, Donna Lorraine via phone (410) 205-9205.

Contact Information

Primary practice address
1600 Crain Hwy S Ste 608 Glen Burnie MD 21061-6442
Fax: (619) 268-5973
Website:
Authorized official contact:
Name: Ticknor, Donna Lorraine Doctor of Medicine (MD)

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X

Profile Details

NPI number 1275382871
LBN Legal business name South River Psychiatric Services, Llc
DBA Doing business as South River Psychiatry
Authorized official Ticknor, Donna Lorraine Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date May 15th, 2024
Last updated May 15th, 2024 - about 7 months ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275382871 NPPES
Other 1720131295 INDIVIDUAL NPI
Other D0086372 INDIVIDUAL NPI

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