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NPI Code Detail

MEDICARE: PHOENIX SUPPORT SERVICES, LLC

MEDICARE: PHOENIX SUPPORT SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist04153MD

General Provider Information

NPI Number : 1023368412
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHOENIX SUPPORT SERVICES, LLC
Provider Business Mailing Address
First Line : 520 STEVENSON LN
Second Line :
City : TOWSON
State : MD
Zip : 21286-7606
Country : US
Telephone Number : 410-714-0077
Fax Number :
Provider Business Practice Location Address
First Line : 6701 N CHARLES ST
Second Line : STE 4104
City : TOWSON
State : MD
Zip : 21204-6808
Country : US
Telephone Number : 410-714-0077
Fax Number :
Authorized Official
Title or Position : OWNER/PSYCHOLOGIST
Name : DR. JAMES ROBERT BARRY
Credential : PH.D.
Telephone Number : 410-714-0077
Provider Enumeration Date : 09/13/2012
Last Update Date : 09/13/2012

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Directions to “PHOENIX SUPPORT SERVICES, LLC ” Practice Location

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