Provider Demographics
NPI:1033085535
Name:REVIVAL PSYCHIATRY AND WELLNESS SERVICES
Entity type:Organization
Organization Name:REVIVAL PSYCHIATRY AND WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MBEBOH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:443-410-6131
Mailing Address - Street 1:2059 BALTIMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048-1301
Mailing Address - Country:US
Mailing Address - Phone:443-410-6131
Mailing Address - Fax:
Practice Address - Street 1:2059 BALTIMORE BLVD
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-1301
Practice Address - Country:US
Practice Address - Phone:443-410-6131
Practice Address - Fax:410-941-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty