Provider Demographics
NPI:1609591957
Name:MARYLAND ANXIETY AND DEPRESSION TREATMENT CENTER
Entity Type:Organization
Organization Name:MARYLAND ANXIETY AND DEPRESSION TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-995-8078
Mailing Address - Street 1:4552 KINGSCUP CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6004
Mailing Address - Country:US
Mailing Address - Phone:410-995-8078
Mailing Address - Fax:
Practice Address - Street 1:5114 DORSEY HALL DR STE 2
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7878
Practice Address - Country:US
Practice Address - Phone:410-995-8078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)