Provider Demographics
NPI:1508275074
Name:MSA THE CHILD AND ADOLESCENT CENTER
Entity Type:Organization
Organization Name:MSA THE CHILD AND ADOLESCENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLUTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5864251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health