Healthcare Provider Details

I. General information

NPI: 1063925188
Provider Name (Legal Business Name): METRO MENTAL HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 QUEENSBURY RD STE 210
RIVERDALE PARK MD
20737-1068
US

IV. Provider business mailing address

4404 QUEENSBURY RD STE 210
RIVERDALE PARK MD
20737-1068
US

V. Phone/Fax

Practice location:
  • Phone: 301-693-0501
  • Fax: 240-582-1393
Mailing address:
  • Phone: 301-693-0501
  • Fax: 240-582-1393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. IMMACULATA ULU
Title or Position: PRESIDENT
Credential: NURSE PRACTITIONER
Phone: 301-693-0501