Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

South River Psychiatric Services, LLC

Organization Psychiatry Physician · NPI 1275382871

South River Psychiatric Services, LLC is a Psychiatry Physician in Glen Burnie, Maryland. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1600 Crain Hwy S Ste 608
Glen Burnie, MD 21061-6442
Phone: (410) 205-9205
Fax: (619) 268-5973
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X

Record details

NPI number1275382871
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Donna Ticknor — Owner/Physician · (410) 205-9205
Other names South River Psychiatry
NPI enumeratedMay 15, 2024
Last updated in NPPESMay 15, 2024
Certification dateMay 15, 2024
Mailing address408 Kathe Ct, Riva, MD 21140-1312

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