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General NPI Number Information
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NPI Number | 1639922560
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Entity Type | Organization
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Legal Business Name | BONI MEDICAL & PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 4030 BLACKBURN LN
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City | BURTONSVILLE
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State | MD
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Zip | 20866-1168
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Country | US
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Telephone | 240-722-6733
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Fax |
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Provider Business Mailing Address
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Address Line | 4030 BLACKBURN LN
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City | BURTONSVILLE
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State | MD
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Zip | 20866-1168
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Country | US
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Telephone | 240-722-6733
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HANNAH NGALE
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Credential |
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Telephone | 301-512-0726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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