Healthcare Provider Details

I. General information

NPI: 1588380562
Provider Name (Legal Business Name): PSYCHFORWARD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 W 36TH ST STE 205
BALTIMORE MD
21211-2415
US

IV. Provider business mailing address

3726 HICKORY AVE
BALTIMORE MD
21211-1809
US

V. Phone/Fax

Practice location:
  • Phone: 410-941-8172
  • Fax:
Mailing address:
  • Phone: 410-941-8172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN SCHETTINO
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 410-941-8172