| Integrated Behavioral Health, Llc | |
|
4200 Forbes Blvd Lanham MD 20706-4342 | |
| (202) 627-6932 | |
| Not Available |
| Full Name | Integrated Behavioral Health, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4200 Forbes Blvd, Lanham, Maryland |
| Authorized Official Name and Position | Satwant Kaur (CEO) |
| Authorized Official Contact | 3014994240 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Behavioral Health, Llc 12404 Winding Ln Bowie MD 20715-1234 Ph: (202) 607-6932 | Integrated Behavioral Health, Llc 4200 Forbes Blvd Lanham MD 20706-4342 Ph: (202) 627-6932 |
| NPI Number | 1780332346 |
|---|---|
| Provider Enumeration Date | 03/14/2022 |
| Last Update Date | 12/06/2022 |
| Certification Date | 12/06/2022 |
| Medicare PECOS PAC ID | 7810280781 |
|---|---|
| Medicare Enrollment ID | O20220816003304 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780332346 | NPI | - | NPPES |
| Provider Name | Marjorie R Madikoto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275938201 PECOS PAC ID: 8628362589 Enrollment ID: I20160816001075 |
| Provider Name | Yolonda Monique Edgerton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184740151 PECOS PAC ID: 9830322817 Enrollment ID: I20210415001961 |
| Provider Name | Kumutha F Daniel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225627136 PECOS PAC ID: 3173932670 Enrollment ID: I20210513002188 |
| Provider Name | Michael J Bohman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467720110 PECOS PAC ID: 0941257364 Enrollment ID: I20220909000910 |
| Provider Name | Temitope Adebusoye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346917200 PECOS PAC ID: 9830574904 Enrollment ID: I20220912000292 |
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