Healthcare Provider Details

I. General information

NPI: 1407507783
Provider Name (Legal Business Name): UNIVERSITY PSYCHOLOGICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 GREENBELT RD STE U3
BERWYN HEIGHTS MD
20740-2361
US

IV. Provider business mailing address

185 ADMIRAL COCHRANE DR STE 120
ANNAPOLIS MD
21401-7600
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-1919
  • Fax:
Mailing address:
  • Phone: 443-440-5782
  • Fax:

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: CHRISTINA PETERSON
Title or Position: BILLING MANAGER
Credential:
Phone: 443-440-5782