| Drlullaby Llc | |
|
822 Guilford Ave Ste 1923 Baltimore MD 21202-3707 | |
| (844) 475-3379 | |
| (855) 644-2987 |
| Full Name | Drlullaby Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 822 Guilford Ave Ste 1923, Baltimore, Maryland |
| Authorized Official Name and Position | Lisa Ann Medalie (CEO) |
| Authorized Official Contact | 6199975759 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Drlullaby Llc 1440 W Taylor St Chicago IL 60607-4623 Ph: (844) 475-3379 | Drlullaby Llc 822 Guilford Ave Ste 1923 Baltimore MD 21202-3707 Ph: (844) 475-3379 |
| NPI Number | 1568178689 |
|---|---|
| Provider Enumeration Date | 01/24/2023 |
| Last Update Date | 03/14/2023 |
| Certification Date | 03/14/2023 |
| Medicare PECOS PAC ID | 9931507290 |
|---|---|
| Medicare Enrollment ID | O20230330000203 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568178689 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Tyler Rickards |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1962807867 PECOS PAC ID: 3870881105 Enrollment ID: I20161019001187 |
| Provider Name | Jayme Hodges |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174939144 PECOS PAC ID: 7416174552 Enrollment ID: I20230330000329 |
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