Provider Demographics
NPI:1083810774
Name:MARYLAND ADDICTIONS & PSYCH INC
Entity Type:Organization
Organization Name:MARYLAND ADDICTIONS & PSYCH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLENDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-228-3929
Mailing Address - Street 1:828 AIRPAX RD
Mailing Address - Street 2:SUITE 300 BLDG- B
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-6405
Mailing Address - Country:US
Mailing Address - Phone:410-228-3929
Mailing Address - Fax:410-228-3810
Practice Address - Street 1:828 AIRPAX RD
Practice Address - Street 2:SUITE 300 BLDG- B
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-6405
Practice Address - Country:US
Practice Address - Phone:410-228-3929
Practice Address - Fax:410-228-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050266251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health