Healthcare Provider Details

I. General information

NPI: 1427763440
Provider Name (Legal Business Name): POTOMAC PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COURTHOUSE SQ STE 216
ROCKVILLE MD
20850-0399
US

IV. Provider business mailing address

PO BOX 60752
POTOMAC MD
20859-0752
US

V. Phone/Fax

Practice location:
  • Phone: 301-244-9685
  • Fax:
Mailing address:
  • Phone: 301-244-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. GENINE SWANZEY-MAHON
Title or Position: OWNER
Credential: PSYD
Phone: 301-244-9685