Provider Demographics
NPI:1508576968
Name:EQUILIBRIUM FOR MENTAL CARE CORPORATION
Entity Type:Organization
Organization Name:EQUILIBRIUM FOR MENTAL CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-775-2752
Mailing Address - Street 1:6550 MERCANTILE DRIVE E
Mailing Address - Street 2:SUITE #206
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703
Mailing Address - Country:US
Mailing Address - Phone:240-815-5201
Mailing Address - Fax:
Practice Address - Street 1:6550 MERCANTILE DRIVE E
Practice Address - Street 2:SUITE #206
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703
Practice Address - Country:US
Practice Address - Phone:240-815-5201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD772042400Medicaid