Provider Demographics
NPI:1083656235
Name:TONER, JACQUELINE BECK (PHD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:BECK
Last Name:TONER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 KENILWORTH DR.
Mailing Address - Street 2:SUITE 503
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2191
Mailing Address - Country:US
Mailing Address - Phone:410-296-6932
Mailing Address - Fax:
Practice Address - Street 1:744 DULANEY VALLEY RD
Practice Address - Street 2:SUITE 8
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5132
Practice Address - Country:US
Practice Address - Phone:410-296-6932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1767103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDGJ37OtherCAREFIRST BC/BS