Provider Demographics
NPI:1093474595
Name:MATRIARCH SERVICES LLC
Entity Type:Organization
Organization Name:MATRIARCH SERVICES LLC
Other - Org Name:MATRIARCH MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC, PMH-C
Authorized Official - Phone:443-244-4211
Mailing Address - Street 1:3715 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3548
Mailing Address - Country:US
Mailing Address - Phone:443-244-4211
Mailing Address - Fax:
Practice Address - Street 1:3715 GLEN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3548
Practice Address - Country:US
Practice Address - Phone:443-244-4211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-12
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty