Provider Demographics
NPI:1538640057
Name:HEFUNA MENTAL HEALTH WELLNESS LLC
Entity Type:Organization
Organization Name:HEFUNA MENTAL HEALTH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:REIDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-590-3230
Mailing Address - Street 1:7474 GREENWAY CENTER DR STE 700A
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3523
Mailing Address - Country:US
Mailing Address - Phone:301-982-3437
Mailing Address - Fax:
Practice Address - Street 1:1003 W 7TH ST STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4106
Practice Address - Country:US
Practice Address - Phone:301-245-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEFUNA MENTAL HEALTH WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD665762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty