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 provides Psychiatry Physician services 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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