Provider Demographics
NPI:1073030581
Name:UNIVERSITY PSYCHOLOGICAL CENTER, INC
Entity Type:Organization
Organization Name:UNIVERSITY PSYCHOLOGICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUDAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-576-9191
Mailing Address - Street 1:6201 GREENBELT RD STE U18
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2361
Mailing Address - Country:US
Mailing Address - Phone:301-345-1919
Mailing Address - Fax:301-345-5779
Practice Address - Street 1:425 E PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5729
Practice Address - Country:US
Practice Address - Phone:301-662-7003
Practice Address - Fax:301-694-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty