| Mentor-maryland | |
|
4200 Forbes Boulevard Suite 100 Lanham MD 20706 | |
| (301) 459-3057 | |
| Not Available |
| Full Name | Mentor-maryland |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4200 Forbes Boulevard, Lanham, Maryland |
| Authorized Official Name and Position | Carol Ivy Simmons (DIRECTOR OMHC) |
| Authorized Official Contact | 4104554600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mentor-maryland 5720 Executive Drive Catonsville MD 21228 Ph: (410) 455-4600 | Mentor-maryland 4200 Forbes Boulevard Suite 100 Lanham MD 20706 Ph: (301) 459-3057 |
| NPI Number | 1023544285 |
|---|---|
| Provider Enumeration Date | 05/10/2017 |
| Last Update Date | 05/10/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023544285 | NPI | - | NPPES |
| 056668 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MH-2278 (Maryland) | Primary |
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Karia Home Health Consulting, LLC Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 7404 Executive Pl Ste 400, Lanham, MD 20706 Phone: 240-639-4430 |
Interdynamics, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4601 Forbes Blvd, Lanham, MD 20706 Phone: 301-306-4590 Fax: 301-306-4591 |
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