Provider Demographics
NPI:1295510113
Name:LONG INTEGRATED PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:LONG INTEGRATED PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEAVNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-508-0722
Mailing Address - Street 1:11560 CROSSROADS CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2885
Mailing Address - Country:US
Mailing Address - Phone:410-508-0722
Mailing Address - Fax:
Practice Address - Street 1:1101 N POINT BLVD STE 131
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3417
Practice Address - Country:US
Practice Address - Phone:410-508-0722
Practice Address - Fax:410-834-1851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONG INTEGRATED PSYCHIATRIC SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty