Provider Demographics
NPI:1154328698
Name:M. SLUTSKY & ASSOCIATES, INC
Entity Type:Organization
Organization Name:M. SLUTSKY & ASSOCIATES, INC
Other - Org Name:MSA THE CHILD & ADOLESCENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLUTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:443-259-0400
Mailing Address - Street 1:10005 OLD COLUMBIA RD
Mailing Address - Street 2:SUITE L260
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1702
Mailing Address - Country:US
Mailing Address - Phone:443-259-0400
Mailing Address - Fax:443-259-0044
Practice Address - Street 1:10005 OLD COLUMBIA RD
Practice Address - Street 2:SUITE L260
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1702
Practice Address - Country:US
Practice Address - Phone:443-259-0400
Practice Address - Fax:443-259-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2384261QM0801X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD214616Medicare ID - Type UnspecifiedCOMMUNITY MENTAL HEALTH