Provider Demographics
NPI:1336676089
Name:UNIVERSITY PSYCHOLOGICAL CENTER, INC
Entity Type:Organization
Organization Name:UNIVERSITY PSYCHOLOGICAL CENTER, INC
Other - Org Name:RECOVERY NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUDAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-576-9191
Mailing Address - Street 1:2425 GUILFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5221
Mailing Address - Country:US
Mailing Address - Phone:410-576-9191
Mailing Address - Fax:410-576-9257
Practice Address - Street 1:2425 GUILFORD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5221
Practice Address - Country:US
Practice Address - Phone:410-576-9191
Practice Address - Fax:410-576-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD906209324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility