Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | G12898 | MD |
N | 103G00000X | Clinical Psychologist | G12898 | MD |
N | 103TC0700X | Clinical Psychologist | G12898 | MD |
N | 103TC1900X | Counseling Psychologist | G12898 | MD |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | G12898 | MD |
N | 103TF0000X | Family Psychologist | G12898 | MD |
N | 103TP2701X | Group Psychotherapist | G12898 | MD |
N | 103TR0400X | Rehabilitation Psychologist | G12898 | MD |
N | 104100000X | Social Worker | G12898 | MD |
Y | 1041C0700X | Clinical Social Worker | G12898 | MD |
NPI | 1194953877 |
---|---|
Provider Name | Kehinde Paul |
First Address | Lanham, MD 20706-4342 |
Second Address | Lanham, MD 20706-4342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 01/07/2009 |