Healthcare Provider Details

I. General information

NPI: 1952570343
Provider Name (Legal Business Name): INTERDYNAMICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8181 PROFESSIONAL PL STE 150&200
LANDOVER MD
20785-2226
US

IV. Provider business mailing address

8181 PROFESSIONAL PL STE 200
LANDOVER MD
20785-7219
US

V. Phone/Fax

Practice location:
  • Phone: 301-306-4590
  • Fax: 301-880-0054
Mailing address:
  • Phone: 301-306-4590
  • Fax: 301-880-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR175350
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number04055
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01160
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number04208
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberG11628
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD32806
License Number StateDC
# 8
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0055667
License Number StateMD

VIII. Authorized Official

Name: JOAN BRANCH
Title or Position: PRESIDENT/CEO
Credential:
Phone: 301-306-4590