Provider Demographics
NPI:1063809549
Name:CHESAPEAKE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:CHESAPEAKE PSYCHOLOGICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NADEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-562-8448
Mailing Address - Street 1:8607 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4324
Mailing Address - Country:US
Mailing Address - Phone:301-562-8448
Mailing Address - Fax:
Practice Address - Street 1:6430 ROCKLEDGE DR STE 500
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1886
Practice Address - Country:US
Practice Address - Phone:301-562-8448
Practice Address - Fax:877-250-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty