1730692278 NPI number — THE INSTITUTE FOR EMOTIONAL REGULATION, LLC

Table of content: (NPI 1730692278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730692278 NPI number — THE INSTITUTE FOR EMOTIONAL REGULATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE INSTITUTE FOR EMOTIONAL REGULATION, LLC
Provider Last Name:
Provider First Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1730692278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16140 GINGER ROOT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDYWINE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20613-4186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 CRAIN HWY STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20603-4843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-297-9992
Provider Business Practice Location Address Fax Number:
800-956-3010
Provider Enumeration Date:
11/07/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
INGRAM
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
C.E.O.
Authorized Official Telephone Number:
202-297-9992

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1730692278 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".