Provider Demographics
NPI:1578893897
Name:T.S. TRASK INC
Entity Type:Organization
Organization Name:T.S. TRASK INC
Other - Org Name:INNOVATIVE CLINICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN-DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-565-0720
Mailing Address - Street 1:8701 GEORGIA AVE
Mailing Address - Street 2:SUITE 611
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3713
Mailing Address - Country:US
Mailing Address - Phone:301-565-0720
Mailing Address - Fax:301-565-0721
Practice Address - Street 1:8701 GEORGIA AVE
Practice Address - Street 2:SUITE 611
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3713
Practice Address - Country:US
Practice Address - Phone:301-565-0720
Practice Address - Fax:301-565-0721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11989251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD540053800Medicaid