Provider Demographics
NPI:1518213982
Name:CONSULTATION AND CRISIS INTERVENTION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CONSULTATION AND CRISIS INTERVENTION ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:410-296-1880
Mailing Address - Street 1:1107 KENILWORTH DR STE 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2136
Mailing Address - Country:US
Mailing Address - Phone:410-296-1880
Mailing Address - Fax:410-494-0368
Practice Address - Street 1:1107 KENILWORTH DR STE 210
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-2136
Practice Address - Country:US
Practice Address - Phone:410-296-1880
Practice Address - Fax:410-494-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04668103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty