SOUTH RIVER PSYCHIATRIC SERVICES LLC NPI 1275382871

NPI Information

  • NPI: 1275382871
  • Provider Name: SOUTH RIVER PSYCHIATRIC SERVICES, LLC
  • Classification: Psychiatry & Neurology - 2084P0800X
  • Specialization: Psychiatry
  • Entity Type: Organization
  • Doing Business As: SOUTH RIVER PSYCHIATRY
  • Address: 1600 CRAIN HWY S STE 608
    GLEN BURNIE, MD
    ZIP 21061
  • Phone: (410) 205-9205

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NPI Details

SOUTH RIVER PSYCHIATRIC SERVICES, LLC is a psychiatry psychiatry neurology in Glen Burnie, MD. The provider is a Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. SOUTH RIVER PSYCHIATRIC SERVICES, LLC NPI is 1275382871. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As South River Psychiatry.

The provider's business location address is:

1600 CRAIN HWY S STE 608
GLEN BURNIE, MD
ZIP 21061-442
Phone: (410) 205-9205
Fax: (619) 268-5973

The provider's authorized official is Donna Lorraine Ticknor .
The authorized official title is Owner/physician and has the following contact phone number (410) 205-9205.

The enumeration date for this NPI number is 5/15/2024 and was last updated on 5/15/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12084P0800XPsychiatry & NeurologyPsychiatryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11720131295OTHERINDIVIDUAL NPI
2D0086372OTHERMARYLANDSTATE MEDICAL LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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