NPIMap

Organization Active NPI

Patricia J Lackey PHD PA

Doing business as Canton Psychological Services

  • Clinical Psychologist
  • Baltimore, MD
National Provider Identifier
1588855662
Registry record updated Aug 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
03096 Issued in MD
Legal business name
PATRICIA J LACKEY PHD PA
Doing business as
Canton Psychological Services
Practice address
2801 Foster Avenue
Baltimore, MD 21224-3816
Phone
(410) 499-7792
Fax
(410) 732-7427
NPI assigned
Aug 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2007

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

Authorized official

Name
Dr. Patricia J Lackey, PHD
Title
Psychologist President
Phone
(410) 499-7792

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 03096 MD Primary

Addresses

Primary practice location

2801 Foster Avenue
Baltimore, MD 21224-3816

Mailing address

13801 York Rd
K14
Cockeysville, MD 21030-1895
Phone (410) 499-7792

Other identifiers 1

IdentifierTypeStateIssuer
K74OtherMDMD BC AND BS

Other names 1

  • Canton Psychological Services Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186272000000",
    "number": "1588855662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13801 YORK RD",
            "address_2": "K14",
            "city": "COCKEYSVILLE",
            "state": "MD",
            "postal_code": "210301895",
            "telephone_number": "410-499-7792",
            "fax_number": "410-732-7427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 FOSTER AVENUE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212243816",
            "telephone_number": "410-499-7792",
            "fax_number": "410-732-7427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRICIA J LACKEY PHD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2007-08-05",
        "status": "A",
        "authorized_official_last_name": "LACKEY",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PSYCHOLOGIST PRESIDENT",
        "authorized_official_telephone_number": "410-499-7792",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "03096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD BC AND BS",
            "identifier": "K74",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canton Psychological Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.