Provider Demographics
NPI:1720469562
Name:PSYCHEXPERTS & ASSOCIATES
Entity Type:Organization
Organization Name:PSYCHEXPERTS & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLI
Authorized Official - Middle Name:
Authorized Official - Last Name:MORMILE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:410-777-8130
Mailing Address - Street 1:611 PARK AVE
Mailing Address - Street 2:SUITE 1-D
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4572
Mailing Address - Country:US
Mailing Address - Phone:410-777-8130
Mailing Address - Fax:410-777-8130
Practice Address - Street 1:5707 CALVERTON ST
Practice Address - Street 2:SUITE 1-D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4154
Practice Address - Country:US
Practice Address - Phone:410-251-2100
Practice Address - Fax:410-777-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05046103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4979001-00Medicaid
MD243136OtherMEDICARE P-TAN