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General NPI Number Information
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NPI Number | 1295562395
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Entity Type | Organization
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Legal Business Name | GOODTIME FAMILY CARE PC
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Dates
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Enumeration Date | 09/14/2024
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 7131 LIBERTY RD STE 103
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City | GWYNN OAK
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State | MD
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Zip | 21207-4580
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Country | US
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Telephone | 410-325-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 7131 LIBERTY RD STE 103
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City | GWYNN OAK
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State | MD
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Zip | 21207-4580
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Country | US
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Telephone | 410-325-5700
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Fax | 410-325-5765
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT/ADMINISTRATOR
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Name | RONDA HERRY
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Credential |
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Telephone | 410-325-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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