Healthcare Provider Details

I. General information

NPI: 1528883311
Provider Name (Legal Business Name): JAMES PERRITT PSYCHIATRIC NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 S MAIN CHAPEL WAY STE 104
GAMBRILLS MD
21054-1860
US

IV. Provider business mailing address

401 GREEN GROVE CT
MILLERSVILLE MD
21108-1469
US

V. Phone/Fax

Practice location:
  • Phone: 410-402-3043
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES PERRITT
Title or Position: NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 410-402-3043