| Crossroads Psychological Associates Llc | |
|
10784 Hickory Ridge Rd Columbia MD 21044-3646 | |
| (410) 964-0425 | |
| (410) 964-0515 |
| Full Name | Crossroads Psychological Associates Llc |
|---|---|
| Speciality | Psychologist |
| Location | 10784 Hickory Ridge Rd, Columbia, Maryland |
| Authorized Official Name and Position | Susan Stacy (ADMINISTRATOR) |
| Authorized Official Contact | 4109640425 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crossroads Psychological Associates Llc 10784 Hickory Ridge Rd Columbia MD 21044-3646 Ph: (410) 964-0425 | Crossroads Psychological Associates Llc 10784 Hickory Ridge Rd Columbia MD 21044-3646 Ph: (410) 964-0425 |
| NPI Number | 1285814079 |
|---|---|
| Provider Enumeration Date | 11/08/2007 |
| Last Update Date | 03/03/2010 |
| Medicare PECOS PAC ID | 9830234962 |
|---|---|
| Medicare Enrollment ID | O20100301000669 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285814079 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Brenda L May |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164418380 PECOS PAC ID: 1052361318 Enrollment ID: I20050125000852 |
| Provider Name | Laura K Renbaum |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073511226 PECOS PAC ID: 9638143829 Enrollment ID: I20050609000666 |
| Provider Name | David M Band |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043316094 PECOS PAC ID: 8325003205 Enrollment ID: I20100421000586 |
| Provider Name | Wanda C Caesar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316288699 PECOS PAC ID: 7517104318 Enrollment ID: I20130515000518 |
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