Provider Demographics
NPI:1780365007
Name:MIRSKY CENTER LLC
Entity type:Organization
Organization Name:MIRSKY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST, CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:240-432-1884
Mailing Address - Street 1:2250 WASHINGTON AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2647
Mailing Address - Country:US
Mailing Address - Phone:240-432-1884
Mailing Address - Fax:
Practice Address - Street 1:2250 WASHINGTON AVE APT 302
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2647
Practice Address - Country:US
Practice Address - Phone:240-432-1884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1336731702OtherNPI