MEDICARE: PSYCHIATRY SPECIALITIES CLINICS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	2084P0800X	Psychiatry Physician
3	363LF0000X	Family Nurse Practitioner
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
5	2084P0802X	Addiction Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851864037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHIATRY SPECIALITIES CLINICS, LLC

Provider Business Mailing Address
First Line	:	3525 ELLICOTT MILLS DR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4547
Country	:	US
Telephone Number	:	410-988-8092
Fax Number	:	443-420-7875

Provider Business Practice Location Address
First Line	:	3525 ELLICOTT MILLS DR STE G
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4638
Country	:	US
Telephone Number	:	410-988-8092
Fax Number	:	443-420-7875

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS RINU PRADHAN
Credential	:
Telephone Number	:	410-988-8092

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	10/10/2023

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