Provider Demographics
NPI:1134527344
Name:MACK, RITA (PMHCNS- BC, MSN)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:MACK
Suffix:
Gender:F
Credentials:PMHCNS- BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 RESEARCH PARK DR
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:215-443-3850
Mailing Address - Fax:215-443-3963
Practice Address - Street 1:10000 ANNS CHOICE WAY
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-3527
Practice Address - Country:US
Practice Address - Phone:215-443-3850
Practice Address - Fax:215-443-3963
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN523062L163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult