Individual provider Active NPI

Lauren Danielle Holder

  • Psychologist
  • Odenton, MD
National Provider Identifier
1114595196
Registry record updated Jun 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
06983 Issued in MD
Practice address
1132 Annapolis Rd
Odenton, MD 21113-1647
Phone
(443) 370-8601
NPI assigned
Jun 15, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X 06983 MD
Clinical Psychologist 103TC0700X 06983 MD
Student in an Organized Health Care Education/Training Program 390200000X MD
Psychologist 103T00000X 06983 MD Primary

Addresses

Primary practice location

1132 Annapolis Rd
Odenton, MD 21113-1647

Mailing address

1032 Miller Cir
Crownsville, MD 21032-1218
Phone (443) 370-8601

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240116001403 MD Practitioner - Clinical Psychologist 8325490352 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
06983MDMDCognitive & Behavioral Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Krieger Associates CurrentSince Dec 6, 2023 Accepting new patients
Kennedy Krieger Associates CurrentSince Dec 6, 2023 Accepting new patients

Locations

1741 Ashland Ave
Ste 642
Baltimore, MD 21205

707 N Broadway
Baltimore, MD 21205
Phone (443) 923-1870

1132 Annapolis Rd
Odenton, MD 21113
Phone (410) 674-0020

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1114595196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1032 MILLER CIR",
            "city": "CROWNSVILLE",
            "state": "MD",
            "postal_code": "210321218",
            "telephone_number": "443-370-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1132 ANNAPOLIS RD",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211131647",
            "telephone_number": "443-370-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDER",
        "first_name": "LAUREN",
        "middle_name": "DANIELLE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-15",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MD",
            "license": "06983",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "06983",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MD",
            "license": "06983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odenton, MD

Sources for this page

Verify at the official NPI Registry.