MEDICARE: TRANSFORMATIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1790155240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMATIONS, LLC

Provider Business Mailing Address
First Line	:	5211 AUTH RD
Second Line	:	SUITE 202B
City	:	SUITLAND
State	:	MD
Zip	:	20746-4339
Country	:	US
Telephone Number	:	301-613-6043
Fax Number	:

Provider Business Practice Location Address
First Line	:	5211 AUTH RD
Second Line	:	SUITE 202B
City	:	SUITLAND
State	:	MD
Zip	:	20746-4339
Country	:	US
Telephone Number	:	301-761-3614
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SOTHIA GREEN
Credential	:	PSYD
Telephone Number	:	301-613-6043

Provider Enumeration Date	:	09/28/2015
Last Update Date	:	04/06/2017

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Directions to “TRANSFORMATIONS, LLC ” Practice Location

Language	Start Address	Practice Location

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