Healthcare Provider Details

I. General information

NPI: 1528280302
Provider Name (Legal Business Name): THE LOYOLA CLINICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 YORK RD SUITE 100
BALTIMORE MD
21212-3048
US

IV. Provider business mailing address

5911 YORK RD SUITE 100
BALTIMORE MD
21212-3048
US

V. Phone/Fax

Practice location:
  • Phone: 410-617-1200
  • Fax: 410-617-1203
Mailing address:
  • Phone: 410-617-1200
  • Fax: 410-617-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3580
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3251
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3823
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4348
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3352
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3543
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4025
License Number StateMD
# 8
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2865
License Number StateMD

VIII. Authorized Official

Name: DR. MARY JO COIRO
Title or Position: DIRECTOR, BHAS
Credential: PH.D.
Phone: 410-617-1200