Provider Demographics
NPI:1962807867
Name:RICKARDS, TYLER (PHD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:RICKARDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 GREENSPRING AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4358
Mailing Address - Country:US
Mailing Address - Phone:410-601-1958
Mailing Address - Fax:410-601-7828
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:MEYER 1-163
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:814-330-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05665103G00000X, 2084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist