Provider Demographics
| NPI: | 1821247081 |
|---|---|
| Name: | BEHAVIORAL HEATH CARE OF MARYLAND |
| Entity Type: | Organization |
| Organization Name: | BEHAVIORAL HEATH CARE OF MARYLAND |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | MEDICAL DIRECTOR/COO |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | MARCELLUS |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | CEPHAS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 301-891-2077 |
| Mailing Address - Street 1: | 7610 CARROLL AVE |
| Mailing Address - Street 2: | SUITE 200 |
| Mailing Address - City: | TAKOMA PARK |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 20912-6384 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 301-891-2077 |
| Mailing Address - Fax: | 301-891-2080 |
| Practice Address - Street 1: | 7610 CARROLL AVE |
| Practice Address - Street 2: | SUITE 200 |
| Practice Address - City: | TAKOMA PARK |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 20912-6384 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 301-891-2077 |
| Practice Address - Fax: | 301-891-2080 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2008-09-12 |
| Last Update Date: | 2009-08-20 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| MD | 20502 | 101YA0400X, 101YM0800X, 103TA0400X, 103TC1900X, 103TC2200X, 103TF0000X, 103TM1800X, 103TP0016X, 103TP2701X, 103TS0200X, 1041C0700X, 106H00000X |
| MD | 103TB0200X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MD | 411884700 | Medicaid |
