Provider Demographics
NPI:1255481644
Name:METROPOLITAN PSYCHOTHERAPY AND HEALTH COACHING, LLC
Entity Type:Organization
Organization Name:METROPOLITAN PSYCHOTHERAPY AND HEALTH COACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ENA
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:PH D, LCSW-C
Authorized Official - Phone:301-899-2497
Mailing Address - Street 1:5625 ALLENTOWN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4521
Mailing Address - Country:US
Mailing Address - Phone:301-899-2497
Mailing Address - Fax:301-899-2499
Practice Address - Street 1:5625 ALLENTOWN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4521
Practice Address - Country:US
Practice Address - Phone:301-899-2497
Practice Address - Fax:301-899-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD051931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD696761200Medicaid
MDG01899Medicare ID - Type UnspecifiedMENTAL HEALTH PROVIDER