CONSULTATION AND CRISIS INTERVENTION ASSOCIATES, LLC - NPI NUMBER 1518213982

Summary

Provider Name: CONSULTATION AND CRISIS INTERVENTION ASSOCIATES, LLC

NPI Number: 1518213982

Clasification: Clinical Neuropsychologist (103G00000X)

Address:
1107 KENILWORTH DR STE 210
BALTIMORE, MD
ZIP 21204

Phone Number: (410) 296-1880



Detailed Information

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
BALTIMORE, MD
ZIP 21204-136
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

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 103G00000X Clinical Neuropsychologist 04668 MD Yes

NPI Record

No. Field Name Field Value
1 NPI 1518213982
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name CONSULTATION AND CRISIS INTERVENTION ASSOCIATES, LLC
5 Provider First Line Business Practice Location Address 1107 KENILWORTH DR STE 210
6 Provider Business Practice Location Address City Name BALTIMORE
7 Provider Business Practice Location Address State Name MD
8 Provider Business Practice Location Address Postal Code 212042136
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 4102961880
11 Provider Business Practice Location Address Fax Number 4104940368
12 Provider Enumeration Date 8/3/2012
13 Last Update Date 8/3/2012
14 Authorized Official Last Name SMITH
15 Authorized Official First Name PETER
16 Authorized Official Title or Position MEDICAL DIRECTOR
17 Authorized Official Telephone Number 4102961880
18 Healthcare Provider Taxonomy Code 1 103G00000X
19 Provider License Number 1 04668
20 Provider License Number State Code 1 MD
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Organization Subpart N
23 Authorized Official Name Prefix Text DR.
24 Authorized Official Credential Text PSYD
25 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 8/12/2014
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.