Provider Demographics
NPI:1659843373
Name:PARKER PSYCHIATRIC SERVICES, INCORPORATED
Entity Type:Organization
Organization Name:PARKER PSYCHIATRIC SERVICES, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-440-0317
Mailing Address - Street 1:940 MADISON AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2113
Mailing Address - Country:US
Mailing Address - Phone:410-440-0317
Mailing Address - Fax:
Practice Address - Street 1:940 MADISON AVE STE 202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2113
Practice Address - Country:US
Practice Address - Phone:410-777-8710
Practice Address - Fax:443-434-0110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKER PSYCHIATRIC SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD422901100Medicaid