1649906496 NPI number — ARUNDEL MENTAL HEALTH PROFESSIONALS LLC

Table of content: (NPI 1649906496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649906496 NPI number — ARUNDEL MENTAL HEALTH PROFESSIONALS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARUNDEL MENTAL HEALTH PROFESSIONALS LLC
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:
LIFESTANCE HEALTH
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:
1649906496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1511 RITCHIE HWY STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARNOLD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21012-2410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-757-2077
Provider Business Mailing Address Fax Number:
410-757-5184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 BESTGATE RD STE 325
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-906-3506
Provider Business Practice Location Address Fax Number:
443-782-2342
Provider Enumeration Date:
07/25/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PARDO
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF LEGAL OFFICER
Authorized Official Telephone Number:
206-399-1493

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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