Provider Demographics
NPI:1548349822
Name:THOMPSON, PATRICIA NOWICKI (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:NOWICKI
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:NOWICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3723 BIRCHMERE CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1298
Mailing Address - Country:US
Mailing Address - Phone:443-286-1107
Mailing Address - Fax:
Practice Address - Street 1:1645 LIBERTY ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784
Practice Address - Country:US
Practice Address - Phone:410-795-4764
Practice Address - Fax:410-795-4462
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD002867103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
322069OtherMHN
002756OtherVALUE OPTIONS
322069OtherHEALTHNET TRICARE
0005982220OtherAETNA
136507OtherCOMPSYCH
055107000OtherMAGELLAN
214467OtherUNITED BEHAVIORAL HEALTH
100026127OtherAMERICAN PSYCH SYSTEMS AP
22975OtherMAMSI
353464OtherPHCS
52656001OtherCAREFIRST BLUE CROSS BLUE
GK03OtherCAREFIRST BLUE CROSS BLUE
R4390001OtherCAREFIRST BLUE CROSS BLUE
214467OtherUNITED BEHAVIORAL HEALTH
GK03Medicare ID - Type Unspecified