Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | ||
Y | 102L00000X | Psychologist | 05442 | MD |
Y | 103T00000X | Psychologist | 05442 | MD |
N | 102L00000X | Psychologist | PSY1001307 | DC |
N | 103T00000X | Psychologist | PSY1001307 | DC |
N | 103G00000X | Clinical Psychologist | 05442 | MD |
N | 103TC0700X | Clinical Psychologist | 05442 | MD |
N | 1041C0700X | Clinical Social Worker | ||
N | 225XM0800X | Mental Health | ||
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1942384185 |
---|---|
Provider Name | Dr. Laray Imani Price |
First Address | Gambrills, MD 21054-1141 |
Second Address | Gambrills, MD 21054-1141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 22/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07944490 | (05) | MD |
360156ZA4B | (02) | MD |