1114250503 NPI number — UNIVERSITY PSYCHOLOGICAL CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114250503 NPI number — UNIVERSITY PSYCHOLOGICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY PSYCHOLOGICAL CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RECOVERY NETWORK
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114250503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 N CHARLES ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21201-4102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-576-9191
Provider Business Mailing Address Fax Number:
410-576-9257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N CHARLES ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-4102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-576-9191
Provider Business Practice Location Address Fax Number:
410-576-9257
Provider Enumeration Date:
09/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HUDAK
Authorized Official First Name:
CLARK
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
410-576-9191

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  903571 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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