Provider Demographics
NPI:1457773160
Name:NEW GENESIS CONSULTING SERVICES
Entity Type:Organization
Organization Name:NEW GENESIS CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SYRETTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-987-1036
Mailing Address - Street 1:112 W PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3669
Mailing Address - Country:US
Mailing Address - Phone:410-838-8331
Mailing Address - Fax:
Practice Address - Street 1:8227 CLOVERLEAF DR STE 303
Practice Address - Street 2:SUITE G
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1536
Practice Address - Country:US
Practice Address - Phone:410-987-1036
Practice Address - Fax:888-224-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04935103T00000X
MD07685104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD331149000Medicaid