Healthcare Provider Details
I. General information
NPI: 1689931594
Provider Name (Legal Business Name): MNK REHABILITATION & PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/16/2012
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2305 ELSINORE AVE
BALTIMORE MD
21216-2119
US
IV. Provider business mailing address
2305 ELSINORE AVE
BALTIMORE MD
21216-2119
US
V. Phone/Fax
- Phone: 410-707-2396
- Fax: 410-884-2897
- Phone: 410-707-2396
- Fax: 410-884-2897
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101Y00000X |
| Taxonomy | Counselor |
| License Number | LCA1596 |
| License Number State | MD |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | LCA1596 |
| License Number State | MD |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | LCA1596 |
| License Number State | MD |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | LCA1596 |
| License Number State | MD |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | 03 |
| License Number State | MD |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Psychologist |
| License Number | 03960 |
| License Number State | MD |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0700X |
| Taxonomy | Adult Development & Aging Psychologist |
| License Number | 04777 |
| License Number State | MD |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TB0200X |
| Taxonomy | Cognitive & Behavioral Psychologist |
| License Number | 0390 |
| License Number State | MD |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC0700X |
| Taxonomy | Clinical Psychologist |
| License Number | 04777 |
| License Number State | MD |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC1900X |
| Taxonomy | Counseling Psychologist |
| License Number | 04777 |
| License Number State | MD |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC2200X |
| Taxonomy | Clinical Child & Adolescent Psychologist |
| License Number | 04777 |
| License Number State | MD |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TF0000X |
| Taxonomy | Family Psychologist |
| License Number | 04777 |
| License Number State | MD |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TP2701X |
| Taxonomy | Group Psychotherapy Psychologist |
| License Number | 04777 |
| License Number State | MD |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 106H00000X |
| Taxonomy | Marriage & Family Therapist |
| License Number | 04777 |
| License Number State | MD |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | 03960 |
| License Number State | MD |
VIII. Authorized Official
Name: DR.
MURUGI
WA
MUNGAI-KAMAU
Title or Position: PRESIDEN
Credential: PH.D.
Phone: 410-707-2396
