Healthcare Provider Details

I. General information

NPI: 1396802567
Provider Name (Legal Business Name): TOWN CENTER PSYCHIATRIC ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MONROE STREET
ROCKVILLE MD
20850
US

IV. Provider business mailing address

208 MONROE STREET
ROCKVILLE MD
20850
US

V. Phone/Fax

Practice location:
  • Phone: 301-309-8200
  • Fax: 301-309-9667
Mailing address:
  • Phone: 301-309-8200
  • Fax: 301-309-9667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER A JACONSKI
Title or Position: BILLING REPRESENTATIVE
Credential:
Phone: 301-953-1266