Provider Demographics
NPI:1962607523
Name:RICKARD, KATHRYN M (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:M
Last Name:RICKARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 FARRAGUT AVE.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2110
Mailing Address - Country:US
Mailing Address - Phone:202-413-3124
Mailing Address - Fax:202-237-2730
Practice Address - Street 1:3720 FARRAGUT AVE.
Practice Address - Street 2:SUITE 103
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2110
Practice Address - Country:US
Practice Address - Phone:202-413-3124
Practice Address - Fax:202-237-2730
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000376103TC0700X, 103T00000X
MD04465103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0162051-01Medicaid