Healthcare Provider Details

I. General information

NPI: 1548097520
Provider Name (Legal Business Name): MICHAEL BOINO PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WEST RD STE 300
TOWSON MD
21204-2370
US

IV. Provider business mailing address

100 WEST RD STE 300
TOWSON MD
21204-2370
US

V. Phone/Fax

Practice location:
  • Phone: 410-417-8197
  • Fax:
Mailing address:
  • Phone: 410-417-8197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL R BOINO
Title or Position: PSYCHOTHERAPIST, OWNER
Credential: LCSW-C
Phone: 410-417-8197