Healthcare Provider Details

I. General information

NPI: 1861129595
Provider Name (Legal Business Name): ARUNDEL MENTAL HEALTH PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 BESTGATE RD
ANNAPOLIS MD
21401-2117
US

IV. Provider business mailing address

1511 RITCHIE HWY STE 202
ARNOLD MD
21012-2410
US

V. Phone/Fax

Practice location:
  • Phone: 443-906-3506
  • Fax: 443-782-2342
Mailing address:
  • Phone: 410-757-2077
  • Fax: 410-757-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: RYAN PARDO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 206-399-1493