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General NPI Number Information
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NPI Number | 1518319201
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Entity Type | Organization
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Legal Business Name | MARIO CONLIFFE
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Dates
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Enumeration Date | 07/06/2016
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 1425 LIBERTY RD SUITE 206
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City | ELDERSBURG
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State | MD
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Zip | 21784-6420
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Country | US
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Telephone | 240-319-3917
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Fax |
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Provider Business Mailing Address
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Address Line | 4470 WOODSMAN DR 731
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City | HAMPSTEAD
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State | MD
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Zip | 21074-3127
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Country | US
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Telephone | 240-319-3917
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. MARIO CONLIFFE
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Credential | MS
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Telephone | 240-319-3917
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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 | LGP6839
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License Number State | MD
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