Provider Demographics
NPI:1669015145
Name:JUSPEN BEHAVIORAL ASSOCIATES.
Entity Type:Organization
Organization Name:JUSPEN BEHAVIORAL ASSOCIATES.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LN
Authorized Official - Phone:301-702-0047
Mailing Address - Street 1:11703 AMER CT
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTION
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2164
Mailing Address - Country:US
Mailing Address - Phone:301-702-0047
Mailing Address - Fax:
Practice Address - Street 1:11703 AMER CT
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTION
Practice Address - State:MD
Practice Address - Zip Code:20744-2164
Practice Address - Country:US
Practice Address - Phone:301-702-0047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty