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
||ERNEST M MAHONE, PHD
||EVERGREEN PSYCHOLOGICAL SERVICES LLC
||DR. JACK SPECTOR, PH.D.
||DR. KERI SHIELS ROSCH, PH.D.
||ARTHUR MACNEILL HORTON, EDD MED DPD
||DR. LISA JOHNSON-GREENE, PH.D.
||GEETA S SARPHARE, PHD
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
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This page was last updated on: 7/15/2014
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