Healthcare Provider Details

I. General information

NPI: 1457710360
Provider Name (Legal Business Name): MPB GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5840 BANNEKER RD STE 270
COLUMBIA MD
21044-3103
US

IV. Provider business mailing address

5840 BANNEKER RD
COLUMBIA MD
21044-3103
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-2385
  • Fax:
Mailing address:
  • Phone: 410-730-2385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH1769
License Number StateMD

VIII. Authorized Official

Name: DR. MAGALIE BREWER
Title or Position: CEO
Credential: PSY.D.
Phone: 410-730-2385