Healthcare Provider Details

I. General information

NPI: 1780272781
Provider Name (Legal Business Name): JMA MENTAL HEALTH AND PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9909 GRANDHAVEN AVE
UPPER MARLBORO MD
20772-6679
US

IV. Provider business mailing address

9909 GRANDHAVEN AVE
UPPER MARLBORO MD
20772-6679
US

V. Phone/Fax

Practice location:
  • Phone: 347-791-9157
  • Fax:
Mailing address:
  • Phone:
  • 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: JANNIE DOH-LAO
Title or Position: OWNER
Credential:
Phone: 347-791-9157