Provider Demographics
NPI:1760631964
Name:OPERATIONAL PSYCHOLOGY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:OPERATIONAL PSYCHOLOGY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:VIETEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:240-237-7502
Mailing Address - Street 1:PO BOX 10960
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-0960
Mailing Address - Country:US
Mailing Address - Phone:410-882-7967
Mailing Address - Fax:410-882-1079
Practice Address - Street 1:44731 SAINT ANDREWS CHURCH RD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-6022
Practice Address - Country:US
Practice Address - Phone:301-769-8081
Practice Address - Fax:410-882-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD530022300Medicaid
MDZCK9Medicare PIN