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General NPI Number Information
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NPI Number | 1265716138
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Entity Type | Organization
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Legal Business Name | TOWSON ADDICTIONS CENTER
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 102 W PENNSYLVANIA AVE STE 306
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City | TOWSON
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State | MD
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Zip | 21204-4543
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Country | US
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Telephone | 410-337-8193
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Fax | 410-337-8192
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Provider Business Mailing Address
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Address Line | 102 W PENNSYLVANIA AVE STE 306
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City | TOWSON
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State | MD
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Zip | 21204-4543
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Country | US
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Telephone | 410-337-8193
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Fax | 410-337-8192
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. PAUL C BERMAN
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Credential | PH.D.
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Telephone | 410-337-8193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 2032
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License Number State | MD
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