1376823823 NPI number — THERAPY @ 9811 INC

Table of content: (NPI 1376823823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376823823 NPI number — THERAPY @ 9811 INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPY @ 9811 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:
Provider Other Organization Name Type Code:
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:
1376823823
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6996 HANOVER PKWY APT 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-2244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-852-2641
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9811 MALLARD DR
Provider Second Line Business Practice Location Address:
SUITE 210/211
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20708-3143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-525-3205
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SOMERVILLE
Authorized Official First Name:
JACCQUELINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ CEO
Authorized Official Telephone Number:
301-525-3205

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  LC2025 , 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)

  • Identifier: ID NUMBER IS TAX ID . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1875 . This is a "CAREFIRST BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 413473700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 676619 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: NO NUMBER ASSIGNED . This is a "CORPHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 676619 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: NO NUMBER ASSIGNED . This is a "CERIDIAN EAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01217038 . This is a "AMERIGROUP MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1875-0001 . This is a "CAREFIST FEP" identifier . This identifiers is of the category "OTHER".
  • Identifier: ID NUMBER IS AN NPI . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: NO NUMBER ASSIGNED . This is a "FIRST ADVANTAGE EAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: NO NUMBER ASSIGNED . This is a "CAREBRIDGE EAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: NO NUMBER ASSIGNED . This is a "INOVA EAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55STJE . This is a "CAREFIRST OF MARYLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7695828 . This is a "AETNA (MHMO, MPPO, MEPO, MCPPO, EAP)" identifier . This identifiers is of the category "OTHER".




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