Provider Demographics
NPI:1235728536
Name:FRED CO MENTAL HEALTH
Entity Type:Organization
Organization Name:FRED CO MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TZORTZINIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-882-7489
Mailing Address - Street 1:11717 OLD NATIONAL PIKE STE 8
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6119
Mailing Address - Country:US
Mailing Address - Phone:301-882-7489
Mailing Address - Fax:
Practice Address - Street 1:11717 OLD NATIONAL PIKE STE 8
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6119
Practice Address - Country:US
Practice Address - Phone:301-882-7489
Practice Address - Fax:301-882-7520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREDERICK COUNTY PEDIATRICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-12
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty