Organization
PATRICIA J LACKEY PHD PA
Active
Other names
Canton Psychological Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICIA J LACKEY PHD (PSYCHOLOGIST PRESIDENT)
(410) 499-7792
Entity
Organization
Contact information
Practice address
2801 FOSTER AVENUE, BALTIMORE, MD 21224-3816
(410) 499-7792
(410) 732-7427
Mailing address
13801 YORK RD, K14, COCKEYSVILLE, MD 21030-1895
(410) 499-7792
(410) 732-7427
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
03096
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K74
MD BC AND BS
MD
Enumeration date
08/05/2007
Last updated
08/05/2007
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