Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 01680 | MD |
NPI | 1225078538 |
---|---|
Provider Name | George S Everly JR. |
First Address | Baltimore, MD 21218 |
Second Address | Baltimore, MD 21218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |