Active NPI
Tyra Joy Decarlo, PHD
- Psychologist
- Towson, MD
National Provider Identifier
1245353473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 02188
- Practice address
- 660 Kenilworth Drive
Ste 101
Towson, MD 21204 - Phone
- (410) 583-5377
- Fax
- (410) 583-1127
- NPI assigned
- Apr 10, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 02188 | MD | Primary |
Addresses
Primary practice location
660 Kenilworth Drive
Ste 101
Towson, MD 21204
Mailing address
660 Kenilworth Drive
Ste 101
Towson, MD 21204
Phone (410) 583-5377
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2021 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245353473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "660 KENILWORTH DRIVE",
"address_2": "STE 101",
"city": "TOWSON",
"state": "MD",
"postal_code": "21204",
"telephone_number": "410-583-5377",
"fax_number": "410-583-5377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "660 KENILWORTH DRIVE",
"address_2": "STE 101",
"city": "TOWSON",
"state": "MD",
"postal_code": "21204",
"telephone_number": "410-583-5377",
"fax_number": "410-583-1127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECARLO",
"first_name": "TYRA",
"middle_name": "JOY",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MD",
"license": "02188",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Towson, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.