| Neurothrive, Llc | |
|
1205 York Rd Ste 11 Lutherville MD 21093-6211 | |
| (443) 810-9483 | |
| Not Available |
| Full Name | Neurothrive, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1205 York Rd Ste 11, Lutherville, Maryland |
| Authorized Official Name and Position | Mark Trullinger (OWNER) |
| Authorized Official Contact | 4438109483 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurothrive, Llc 13941 Alderton Rd Silver Spring MD 20906-2063 Ph: () - | Neurothrive, Llc 1205 York Rd Ste 11 Lutherville MD 21093-6211 Ph: (443) 810-9483 |
| NPI Number | 1063890556 |
|---|---|
| Provider Enumeration Date | 05/15/2015 |
| Last Update Date | 04/25/2016 |
| Medicare PECOS PAC ID | 4486948254 |
|---|---|
| Medicare Enrollment ID | O20160802003140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063890556 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 04502 (Maryland) | Primary |
| Provider Name | Kiu Eubanks Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043536709 PECOS PAC ID: 4183859275 Enrollment ID: I20131025000978 |
| Provider Name | Henry E Pigott |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1619312204 PECOS PAC ID: 4284927591 Enrollment ID: I20180531000496 |
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