Healthcare Provider Details

I. General information

NPI: 1588717722
Provider Name (Legal Business Name): EMMORTON PSYCH CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 EMMORTON RD
ABINGDON MD
21009-2582
US

IV. Provider business mailing address

3105 EMMORTON RD
ABINGDON MD
21009-2582
US

V. Phone/Fax

Practice location:
  • Phone: 410-569-5900
  • Fax: 410-569-7751
Mailing address:
  • Phone: 410-569-5900
  • Fax: 410-569-7751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01971
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMD

VIII. Authorized Official

Name: DR. STEVEN C ZIMMERMAN
Title or Position: ADMINISTRATOR
Credential: PH.D.
Phone: 410-569-5900