Provider Demographics
NPI:1649656943
Name:CORE CLINICAL SERVICES
Entity type:Organization
Organization Name:CORE CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARQUERITE
Authorized Official - Middle Name:PETRANELLA
Authorized Official - Last Name:LABAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-371-7187
Mailing Address - Street 1:9475 DEERECO RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2118
Mailing Address - Country:US
Mailing Address - Phone:410-560-6135
Mailing Address - Fax:410-560-6136
Practice Address - Street 1:9475 DEERECO RD
Practice Address - Street 2:SUITE 410
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2118
Practice Address - Country:US
Practice Address - Phone:410-560-6135
Practice Address - Fax:410-560-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05420103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD717002500Medicaid
MD351583Medicare UPIN