Healthcare Provider Details

I. General information

NPI: 1124433412
Provider Name (Legal Business Name): UNIVERSITY PSYCHOLOGICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N CHARLES ST SUITE 200
BALTIMORE MD
21201-4102
US

IV. Provider business mailing address

201 N CHARLES ST SUITE 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

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