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General NPI Number Information
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NPI Number | 1043511173
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Entity Type | Organization
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Legal Business Name | SAMORAJCZYK PSYCHOLOGICAL SERVICES PA
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Dates
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Enumeration Date | 11/05/2010
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 19205 SENECA RIDGE CT
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City | GAITHERSBURG
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State | MD
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Zip | 20886-3921
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Country | US
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Telephone | 301-869-1755
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Fax | 410-266-5950
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Provider Business Mailing Address
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Address Line | 19205 SENECA RIDGE CT
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City | GAITHERSBURG
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State | MD
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Zip | 20886-3921
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Country | US
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Telephone | 301-869-1755
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Fax | 410-266-5950
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JOHN F SAMORAJCZYK
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Credential | PHD
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Telephone | 301-869-1755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 00497
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License Number State | MD
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