Healthcare Provider Details

I. General information

NPI: 1730143991
Provider Name (Legal Business Name): EMERALD HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 MAIN ST
REISTERSTOWN MD
21136-1213
US

IV. Provider business mailing address

217 MAIN ST
REISTERSTOWN MD
21136-1213
US

V. Phone/Fax

Practice location:
  • Phone: 410-833-0580
  • Fax: 410-833-8604
Mailing address:
  • Phone: 410-833-0580
  • Fax: 410-833-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberD0020136
License Number StateMD

VIII. Authorized Official

Name: MS. LUZ J. E. CORREA-CASHDOLLAR
Title or Position: PRACTICE MANAGER
Credential: R.N.
Phone: 410-833-0580