Provider Demographics
NPI:1700112083
Name:GAITHERSBURG MENTAL HEALTH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:GAITHERSBURG MENTAL HEALTH ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-948-1769
Mailing Address - Street 1:915 RUSSELL AVE
Mailing Address - Street 2:A
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3202
Mailing Address - Country:US
Mailing Address - Phone:301-948-1769
Mailing Address - Fax:301-990-7111
Practice Address - Street 1:915 RUSSELL AVE
Practice Address - Street 2:A
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3202
Practice Address - Country:US
Practice Address - Phone:301-948-1769
Practice Address - Fax:301-990-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD146691700Medicaid
G01874Medicare PIN