Provider Demographics
NPI:1639393622
Name:FAMILY PSYCHOLOGICAL CENTER LLC
Entity Type:Organization
Organization Name:FAMILY PSYCHOLOGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSTEK
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:410-569-7582
Mailing Address - Street 1:2021 EMMORTON RD # A
Mailing Address - Street 2:STE 210
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6138
Mailing Address - Country:US
Mailing Address - Phone:410-569-7582
Mailing Address - Fax:410-569-7583
Practice Address - Street 1:2021 EMMORTON RD # A
Practice Address - Street 2:STE 210
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6138
Practice Address - Country:US
Practice Address - Phone:410-569-7582
Practice Address - Fax:410-569-7583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD313494103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty