MEDICARE: METROPOLITAN BEHAVIORAL HEALTH CARE, 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	PSYC826	DC

General Provider Information

NPI Number	:	1932389723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPOLITAN BEHAVIORAL HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	8811 COLESVILLE RD
Second Line	:	SUITE 104
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4343
Country	:	US
Telephone Number	:	301-585-5539
Fax Number	:	301-587-4327

Provider Business Practice Location Address
First Line	:	910 17TH ST NW
Second Line	:	SUITE 306
City	:	WASHINGTON
State	:	DC
Zip	:	20006-2601
Country	:	US
Telephone Number	:	202-452-6257
Fax Number	:	202-530-0744

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RONALD LEE KIMBALL
Credential	:	PHD
Telephone Number	:	202-452-6257

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	11/08/2007

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