| Doctor Name: | KEVIN RICHARD GORMLEY |
| NPI Number: | 1033553565 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSYD |
| License Number: | 05041 |
| Business Practice Address: | 30 Greenway St Nw Ste 5 Glen Burnie, MD - 210613557 |
| Business Phone Number: | 4107609079 |
| Business Fax Number: | |
| Mailing Address: | 30 Greenway St Nw Ste 5, GLEN BURNIE |
| State: | MD |
| Postal Code: | 210613557 |
| Phone Number: | 4107609079 |
| Fax Number: | |
| NPI Enumeration Date: | 04/26/2013 |
| NPI Last Update Date: | 04/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 05041 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |