Provider Demographics
NPI:1578205886
Name:MARYLAND WELLNESS AND RECOVERY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MARYLAND WELLNESS AND RECOVERY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GERAMIFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-272-5551
Mailing Address - Street 1:11125 ROCKVILLE PIKE STE 302
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3142
Mailing Address - Country:US
Mailing Address - Phone:240-242-4225
Mailing Address - Fax:240-559-1571
Practice Address - Street 1:11125 ROCKVILLE PIKE STE 302
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:240-242-4225
Practice Address - Fax:240-559-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD222730400Medicaid