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General NPI Number Information
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NPI Number | 1972069201
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Entity Type | Organization
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Legal Business Name | HARBORSIDE BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 41625 PARK AVE
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City | LEONARDTOWN
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State | MD
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Zip | 20650-3894
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Country | US
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Telephone | 301-494-1009
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Fax | 970-296-5636
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Provider Business Mailing Address
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Address Line | PO BOX 452
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City | VALLEY LEE
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State | MD
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Zip | 20692-0452
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Country | US
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Telephone | 443-401-1376
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Fax | 970-296-5636
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Authorized Official
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Title or Position | OWNER
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Name | SABRINA SEPULVEDA
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Credential | CRNP-PMH
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Telephone | 301-494-1009
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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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