Provider Demographics
NPI:1659977031
Name:RENEWED MIND PSYCHOTHERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:RENEWED MIND PSYCHOTHERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-916-0718
Mailing Address - Street 1:6919 ROCKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-8023
Mailing Address - Country:US
Mailing Address - Phone:443-916-0718
Mailing Address - Fax:
Practice Address - Street 1:6919 ROCKFIELD RD
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-8023
Practice Address - Country:US
Practice Address - Phone:443-916-0718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty