Healthcare Provider Details

I. General information

NPI: 1649549411
Provider Name (Legal Business Name): C.A. MAYO AND ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 PERRY ST
MOUNT RAINIER MD
20712-2139
US

IV. Provider business mailing address

3403 PERRY ST
MOUNT RAINIER MD
20712-2139
US

V. Phone/Fax

Practice location:
  • Phone: 301-699-0344
  • Fax: 301-699-0343
Mailing address:
  • Phone: 301-699-0344
  • Fax: 301-699-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number001685
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number001685
License Number StateMD

VIII. Authorized Official

Name: DR. C. ANTHONY MAYO
Title or Position: CEO
Credential: DSW
Phone: 301-699-0344