Healthcare Provider Details

I. General information

NPI: 1255195152
Provider Name (Legal Business Name): MENTAL WEALTH PSYCHIATRIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E NAYLOR MILL RD UNIT C
SALISBURY MD
21804-2278
US

IV. Provider business mailing address

1910 TOWNE CENTRE BLVD STE 250
ANNAPOLIS MD
21401-3599
US

V. Phone/Fax

Practice location:
  • Phone: 443-345-2275
  • Fax: 443-300-9504
Mailing address:
  • Phone: 443-345-2275
  • Fax:

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: SIANA BROWN
Title or Position: CEO
Credential: CRNP-PMH
Phone: 443-345-2275