Healthcare Provider Details

I. General information

NPI: 1548863095
Provider Name (Legal Business Name): SENIOR CARE THERAPY PSYCHOLOGY OF MARYLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 GUILFORD AVE # 1526
BALTIMORE MD
21202-3707
US

IV. Provider business mailing address

85 CRESCENT AVE
PASSAIC NJ
07055-2437
US

V. Phone/Fax

Practice location:
  • Phone: 973-264-0023
  • Fax: 973-264-0022
Mailing address:
  • Phone: 973-264-0023
  • Fax: 973-262-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARAH SCIMEME
Title or Position: OWNER
Credential:
Phone: 973-264-0023