Healthcare Provider Details

I. General information

NPI: 1588689483
Provider Name (Legal Business Name): PSYCHOGERIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10320 LITTLE PATUXENT PKWY STE 200
COLUMBIA MD
21044-3344
US

IV. Provider business mailing address

10320 LITTLE PATUXENT PKWY STE 200
COLUMBIA MD
21044-3344
US

V. Phone/Fax

Practice location:
  • Phone: 301-593-1315
  • Fax: 301-681-4699
Mailing address:
  • Phone: 301-593-1315
  • Fax: 301-681-4699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CLIFFORD NELSON
Title or Position: CEO
Credential:
Phone: 301-593-1315