South River Psychiatric Services, LLC
NPI 1275382871ActiveOrganization· Psychiatry & Neurology, Psychiatry· Glen Burnie, MD
Psychiatry & Neurology, Psychiatry in Glen Burnie, Maryland, registered in NPPES in May 2024. The authorized official on file is Donna Lorraine Ticknor, MD, Owner/Physician.
Overview
| NPI | 1275382871 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 15, 2024 |
| Last updated in NPPES | May 15, 2024 |
| Certified by provider | May 15, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychiatry & Neurology, Psychiatry Primary | 2084P0800X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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