Healthcare Provider Details

I. General information

NPI: 1053679225
Provider Name (Legal Business Name): CIS & H, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 BRIGHTSEAT RD
LANDOVER MD
20785-4250
US

IV. Provider business mailing address

1839 BRIGHTSEAT RD
LANDOVER MD
20785-4250
US

V. Phone/Fax

Practice location:
  • Phone: 301-364-3300
  • Fax:
Mailing address:
  • Phone: 301-364-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ALFRED SIBEDWO
Title or Position: DIRECTOR
Credential:
Phone: 240-508-3244