Healthcare Provider Details

I. General information

NPI: 1336463140
Provider Name (Legal Business Name): WHITE MARSH PSYCHIATRIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5024 CAMPBELL BLVD SUITE H
BALTIMORE MD
21236-5974
US

IV. Provider business mailing address

5024 CAMPBELL BLVD SUITE H
BALTIMORE MD
21236-5974
US

V. Phone/Fax

Practice location:
  • Phone: 410-931-9280
  • Fax: 410-931-6694
Mailing address:
  • Phone: 410-931-9280
  • Fax: 410-931-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DONN TEUBNER-RHODES
Title or Position: PREDIDENT
Credential: MD
Phone: 410-931-9280