Provider Demographics
NPI:1518319201
Name:MARIO CONLIFFE
Entity Type:Organization
Organization Name:MARIO CONLIFFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:240-319-3917
Mailing Address - Street 1:4470 WOODSMAN DR
Mailing Address - Street 2:731
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-3127
Mailing Address - Country:US
Mailing Address - Phone:240-319-3917
Mailing Address - Fax:
Practice Address - Street 1:1425 LIBERTY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6420
Practice Address - Country:US
Practice Address - Phone:240-319-3917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6839251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health