CONSULTATION AND CRISIS INTERVENTION ASSOCIATES, LLC - NPI NUMBER 1518213982
Provider Name: CONSULTATION AND CRISIS INTERVENTION ASSOCIATES, LLC
NPI Number: 1518213982
Clasification: Clinical Neuropsychologist (103G00000X)
1107 KENILWORTH DR STE 210
Phone Number: (410) 296-1880
CONSULTATION AND CRISIS INTERVENTION ASSOCIATES, LLC is a clinical neuropsychologist in Baltimore, MD. The provider is an individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. The assigned NPI number for this provider is 1518213982 and is registered as an organization entity type and is a single specialty group.
The provider's business address is:
1107 KENILWORTH DR STE 210
Phone: (410) 296-1880
Fax: (410) 494-0368
The provider's authorized official is Peter Smith .
The authorized official title is Medical Director and has the following contact phone number (410) 296-1880.
The enumeration date for this NPI number is 8/3/2012 and was last updated on 8/3/2012.
Map - Location of Practice
||EVERGREEN PSYCHOLOGICAL SERVICES LLC
||GEETA S SARPHARE, PHD
||ERNEST M MAHONE, PHD
||ARTHUR MACNEILL HORTON, EDD MED DPD
||DR. LISA JOHNSON-GREENE, PH.D.
||DR. JACK SPECTOR, PH.D.
||DR. KERI SHIELS ROSCH, PH.D.
The following information regarding the scope of practice of this provider is available:
||Entity Type Code
||Employer Identification Number EIN
||Provider Organization Name Legal Business Name
||CONSULTATION AND CRISIS INTERVENTION ASSOCIATES, LLC
||Provider First Line Business Practice Location Address
||1107 KENILWORTH DR STE 210
||Provider Business Practice Location Address City Name
||Provider Business Practice Location Address State Name
||Provider Business Practice Location Address Postal Code
||Provider Business Practice Location Address Country Code If outside U S
||Provider Business Practice Location Address Telephone Number
||Provider Business Practice Location Address Fax Number
||Provider Enumeration Date
||Last Update Date
||Authorized Official Last Name
||Authorized Official First Name
||Authorized Official Title or Position
||Authorized Official Telephone Number
||Healthcare Provider Taxonomy Code 1
||Provider License Number 1
||Provider License Number State Code 1
||Healthcare Provider Primary Taxonomy Switch 1
||Is Organization Subpart
||Authorized Official Name Prefix Text
||Authorized Official Credential Text
||Healthcare Provider Taxonomy Group 1
||193400000X SINGLE SPECIALTY GROUP
Download this NPI record in Text format: Export
Download this NPI record in Excel (CSV) format: Export
Download this NPI record in XML format: Export
This page was last updated on: 11/14/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.