Provider Demographics
NPI:1003637463
Name:JUNCO BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:JUNCO BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLERU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-520-2965
Mailing Address - Street 1:12501 OLD CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-8966
Mailing Address - Country:US
Mailing Address - Phone:240-520-2965
Mailing Address - Fax:
Practice Address - Street 1:7350 VAN DUSEN RD STE 390
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5231
Practice Address - Country:US
Practice Address - Phone:240-520-2965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty