Provider Demographics
NPI:1952668055
Name:FAMILY SERVICE INSTITUTE
Entity Type:Organization
Organization Name:FAMILY SERVICE INSTITUTE
Other - Org Name:DENISE TROTTER GLYNN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:TROTTER
Authorized Official - Last Name:GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-512-4689
Mailing Address - Street 1:1300 MERCANTILE LN
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5327
Mailing Address - Country:US
Mailing Address - Phone:301-512-4689
Mailing Address - Fax:301-773-1443
Practice Address - Street 1:1300 MERCANTILE LN
Practice Address - Street 2:SUITE 136 C
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:301-512-4689
Practice Address - Fax:301-773-1443
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD776800100Medicaid