Healthcare Provider Details

I. General information

NPI: 1568762599
Provider Name (Legal Business Name): CORSICA RIVER MENTAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 01/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 S TALBOT ST SUITE 4
ST MICHAELS MD
21663-2604
US

IV. Provider business mailing address

120 BANJO LN P.O. BOX 718
CENTREVILLE MD
21617-1002
US

V. Phone/Fax

Practice location:
  • Phone: 410-745-8028
  • Fax: 410-745-0492
Mailing address:
  • Phone: 410-758-2211
  • Fax: 410-758-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN F. PLASKON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-758-3050