MEDICARE: ARUNDEL MENTAL HEALTH PROFESSIONALS 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
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1053047894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARUNDEL MENTAL HEALTH PROFESSIONALS LLC

Provider Business Mailing Address
First Line	:	1511 RITCHIE HWY STE 202
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-2410
Country	:	US
Telephone Number	:	410-757-2077
Fax Number	:	410-757-5184

Provider Business Practice Location Address
First Line	:	2431 SOLOMONS ISLAND RD STE 200
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3730
Country	:	US
Telephone Number	:	410-757-2077
Fax Number	:	410-721-2357

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	RYAN PARDO
Credential	:
Telephone Number	:	206-399-1493

Provider Enumeration Date	:	07/25/2022
Last Update Date	:	06/28/2023

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