Healthcare Provider Details

I. General information

NPI: 1588425516
Provider Name (Legal Business Name): URBAN BEHAVIORAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16701 MELFORD BLVD STE 400
BOWIE MD
20715-4411
US

IV. Provider business mailing address

13515 MARY BOWIE PKWY
UPPER MARLBORO MD
20774-9073
US

V. Phone/Fax

Practice location:
  • Phone: 202-836-7776
  • Fax:
Mailing address:
  • Phone: 443-841-4969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACEE BURROUGHS-GARDNER
Title or Position: CEO
Credential: MD
Phone: 202-836-7776