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General NPI Number Information
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NPI Number | 1073030581
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PSYCHOLOGICAL CENTER, INC
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 425 E PATRICK ST
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City | FREDERICK
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State | MD
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Zip | 21701-5729
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Country | US
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Telephone | 301-662-7003
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Fax | 301-694-8527
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Provider Business Mailing Address
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Address Line | 6201 GREENBELT RD STE U18
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City | BERWYN HEIGHTS
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State | MD
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Zip | 20740-2361
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Country | US
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Telephone | 301-345-1919
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Fax | 301-345-5779
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. CLARK J HUDAK JR.
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Credential | PH.D.
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Telephone | 410-576-9191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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