Provider Demographics
NPI:1518119668
Name:METROPOLITAN MENTAL HEALTH CLINIC
Entity Type:Organization
Organization Name:METROPOLITAN MENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAKEITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULBARR
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-324-0600
Mailing Address - Street 1:96 HARRY S TRUMAN DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1000
Mailing Address - Country:US
Mailing Address - Phone:301-324-0600
Mailing Address - Fax:
Practice Address - Street 1:96 HARRY S TRUMAN DR
Practice Address - Street 2:SUITE 250
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1000
Practice Address - Country:US
Practice Address - Phone:301-324-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404173900Medicaid