Healthcare Provider Details

I. General information

NPI: 1497083760
Provider Name (Legal Business Name): UNIVERSITY PSYCHOLOGICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N CHARLES ST 200
BALTIMORE MD
21201-4102
US

IV. Provider business mailing address

201 N CHARLES ST 200
BALTIMORE MD
21201-4102
US

V. Phone/Fax

Practice location:
  • Phone: 410-576-9191
  • Fax: 410-576-9257
Mailing address:
  • Phone: 410-576-9191
  • Fax: 410-576-9257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. CLARK J HUDAK JR.
Title or Position: DIRECTOR/OWNER
Credential: PH.D.
Phone: 410-576-9191