Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSYA200001241 | DC |
Y | 103TC0700X | Clinical Psychologist | PSYA200001241 | DC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSYA200001241 | DC |
NPI | 1083385694 |
---|---|
Provider Name | Dr. Patrick Kenneth Love |
First Address | Bethesda, MD 20814-5244 |
Second Address | Bethesda, MD 20814-5244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2021 |
Last Update Date | 15/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSYA200001241 | WASHINGTON DC PSYCHOLOGICAL ASSOCIATE LICENSE (01) | DC |