Healthcare Provider Details

I. General information

NPI: 1013775063
Provider Name (Legal Business Name): OPTIMAL CARE PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 RITCHIE HWY STE 200
GLEN BURNIE MD
21061-3065
US

IV. Provider business mailing address

7310 RITCHIE HWY STE 200
GLEN BURNIE MD
21061-3065
US

V. Phone/Fax

Practice location:
  • Phone: 240-728-7544
  • Fax: 240-593-5691
Mailing address:
  • Phone: 240-728-7544
  • Fax: 240-593-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: YETUNDE OLOTO
Title or Position: OWNER
Credential: CRNP
Phone: 240-714-9488