Healthcare Provider Details

I. General information

NPI: 1154674224
Provider Name (Legal Business Name): FRIENDS RESEARCH INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 STEMMERS RUN RD SUITE E
ESSEX MD
21221-3386
US

IV. Provider business mailing address

1040 PARK AVE SUITE 103
BALTIMORE MD
21201-5633
US

V. Phone/Fax

Practice location:
  • Phone: 410-574-2500
  • Fax: 410-574-4478
Mailing address:
  • Phone: 410-837-3977
  • Fax: 410-752-4218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN ANN TANGIRES
Title or Position: DIRECTOR
Credential: LCPC, LCADC
Phone: 410-744-4661