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General NPI Number Information
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NPI Number | 1518213982
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Entity Type | Organization
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Legal Business Name | CONSULTATION AND CRISIS INTERVENTION ASSOCIATES, LLC
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 1107 KENILWORTH DR STE 210
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City | BALTIMORE
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State | MD
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Zip | 21204-2136
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Country | US
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Telephone | 410-296-1880
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Fax | 410-494-0368
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Provider Business Mailing Address
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Address Line | 1107 KENILWORTH DR STE 210
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City | BALTIMORE
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State | MD
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Zip | 21204-2136
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Country | US
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Telephone | 410-296-1880
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Fax | 410-494-0368
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PETER SMITH
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Credential | PSYD
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Telephone | 410-296-1880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 04668
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License Number State | MD
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