Individual provider Active NPI

Jerry Lawler, PHD

  • Psychologist
  • Glen Burnie, MD
National Provider Identifier
1710076278
Registry record updated Mar 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
03765 Issued in MD
Practice address
30 Greenway St NW Ste 5
Glen Burnie, MD 21061-3557
Phone
(410) 760-9079
Fax
(410) 760-1121
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 03765 MD Primary

Addresses

Primary practice location

30 Greenway St NW Ste 5
Glen Burnie, MD 21061-3557

Mailing address

30 Greenway St NW Ste 5
Glen Burnie, MD 21061-3557
Phone (410) 760-9079

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
03765MDMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Jerry T. Lawler PHD Psychologist LLC CurrentSince May 15, 2026 Accepting new patients
Safe Harbor Christian Counseling LLC CurrentSince Sep 1, 2017 Accepting new patients
Oasis the Mental Health Center, LLC CurrentSince Jan 29, 2023 Accepting new patients
Safe Harbor Behavioral Care, LLC Psychologist CurrentSince Nov 1, 2017 Accepting new patients

Locations

1208 E Churchville Rd
Ste 300
Bel Air, MD 21014
Phone (410) 838-9500

2227 Old Emmorton Rd
Ste 119
Bel Air, MD 21015
Phone (410) 561-9497

5054 Dorsey Hall Dr
Ellicott City, MD 21042
Phone (410) 730-0122

30 Greenway St NW
Ste 5
Glen Burnie, MD 21061
Phone 41076090790

5430 Campbell Blvd
Ste 211
White Marsh, MD 21162
Phone (410) 838-9500

Organizations & group practices 4

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521504000000",
    "number": "1710076278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 GREENWAY ST NW STE 5",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210613557",
            "telephone_number": "410-760-9079",
            "fax_number": "410-760-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 GREENWAY ST NW STE 5",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210613557",
            "telephone_number": "410-760-9079",
            "fax_number": "410-760-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWLER",
        "first_name": "JERRY",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2018-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MD",
            "license": "03765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

Verify at the official NPI Registry.