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NPI Code Detail

MEDICARE: PSI SERVICES III, INC.

MEDICARE: PSI SERVICES III, INC.
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
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker
3261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1942578133
Entity Type Code : Organization
Provider Name (Legal Business Name) : PSI SERVICES III, INC.
Provider Business Mailing Address
First Line : 8301 PROFESSIONAL PL STE 205
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20785-2353
Country : US
Telephone Number : 301-552-7120
Fax Number : 301-654-4418
Provider Business Practice Location Address
First Line : 5820 DIX ST NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20019-6965
Country : US
Telephone Number : 202-547-3870
Fax Number :
Authorized Official
Title or Position : CHIEF ADVANCEMENT OFFICER
Name : MS. SHAWN RUBBIN
Credential :
Telephone Number : 301-552-7120
Provider Enumeration Date : 12/02/2011
Last Update Date : 04/08/2024

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