Healthcare Provider Details

I. General information

NPI: 1093074064
Provider Name (Legal Business Name): EASTERN SHORE PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 HEALTHWAY DRIVE
SALISBURY MD
21804
US

IV. Provider business mailing address

1113 HEALTHWAY DRIVE
SALISBURY MD
21804
US

V. Phone/Fax

Practice location:
  • Phone: 410-334-6961
  • Fax: 410-334-6362
Mailing address:
  • Phone: 410-334-6961
  • Fax: 410-334-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY KATHRYN SEIFERT
Title or Position: EXECUTIVE CEO
Credential: PH.D
Phone: 410-334-6961