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General NPI Number Information
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NPI Number | 1598582850
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Entity Type | Organization
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Legal Business Name | GREEN DOOR FAMILY PSYCHIATRY LLC
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 4690 MILLENNIUM DR STE 348
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City | BELCAMP
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State | MD
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Zip | 21017-1523
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Country | US
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Telephone | 410-652-6701
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Fax | 844-689-1134
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Provider Business Mailing Address
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Address Line | 4690 MILLENNIUM DR STE 348
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City | BELCAMP
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State | MD
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Zip | 21017-1523
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Country | US
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Telephone | 410-652-6701
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Fax | 844-689-1134
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE SHANEYFELT-JARZYNSKI
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Credential | NP
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Telephone | 410-652-6701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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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