Provider Demographics
NPI:1780184564
Name:IMPERIAL PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:IMPERIAL PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:EMELDA
Authorized Official - Middle Name:FRI
Authorized Official - Last Name:NJEI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:410-572-4738
Mailing Address - Street 1:1813 SWEETBAY DR STE 7
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1663
Mailing Address - Country:US
Mailing Address - Phone:410-572-4738
Mailing Address - Fax:410-572-4649
Practice Address - Street 1:100 E PATAPSCO AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1733
Practice Address - Country:US
Practice Address - Phone:667-239-3144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-18
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR193904363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty