MEDICARE: MEDOP BEHAVIORAL HEALTH ASSOCIATES OF MARYLAND PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	1041C0700X	Clinical Social Worker	MD
2	103TC0700X	Clinical Psychologist	MD
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	MD
4	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	MD
5	2084P0800X	Psychiatry Physician	MD

General Provider Information

NPI Number	:	1447203963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDOP BEHAVIORAL HEALTH ASSOCIATES OF MARYLAND PC

Provider Business Mailing Address
First Line	:	55 HATCHETTS HILL RD
Second Line	:
City	:	OLD LYME
State	:	CT
Zip	:	06371-1534
Country	:	US
Telephone Number	:	800-370-3651
Fax Number	:	866-510-0020

Provider Business Practice Location Address
First Line	:	7 SAINT PAUL ST
Second Line	:	SUITE 820
City	:	BALTIMORE
State	:	MD
Zip	:	21202-1626
Country	:	US
Telephone Number	:	800-370-3651
Fax Number	:	860-510-0020

Authorized Official
Title or Position	:	CFO
Name	:	MS. DONNA DOOLEY
Credential	:
Telephone Number	:	800-370-3651

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/30/2016

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