Provider Demographics
NPI:1447893615
Name:LADYSH, RACHEL (PSYD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LADYSH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 FRONT AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5364
Mailing Address - Country:US
Mailing Address - Phone:410-696-5012
Mailing Address - Fax:
Practice Address - Street 1:1400 FRONT AVE STE 305
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5364
Practice Address - Country:US
Practice Address - Phone:410-696-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07264103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical