Provider Demographics
NPI:1821031543
Name:ATLANTIC PSYCHOLOGICAL PRACTICE, P.A.
Entity Type:Organization
Organization Name:ATLANTIC PSYCHOLOGICAL PRACTICE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RICHARDSON
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-543-8291
Mailing Address - Street 1:106 MILFORD ST.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6966
Mailing Address - Country:US
Mailing Address - Phone:410-543-8291
Mailing Address - Fax:
Practice Address - Street 1:106 MILFORD ST.
Practice Address - Street 2:SUITE 104
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6966
Practice Address - Country:US
Practice Address - Phone:410-543-8291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2756103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD644221800Medicaid
MD644221800Medicaid
118P318GMedicare PIN