Provider Demographics
NPI:1841647617
Name:UNIVERSITY PSYCHOLOGICAL CENTER, INC
Entity type:Organization
Organization Name:UNIVERSITY PSYCHOLOGICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUDAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-576-9191
Mailing Address - Street 1:21 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5003
Mailing Address - Country:US
Mailing Address - Phone:410-366-1717
Mailing Address - Fax:410-889-4176
Practice Address - Street 1:21 W 25TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5003
Practice Address - Country:US
Practice Address - Phone:410-366-1717
Practice Address - Fax:410-889-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
MDMH-1881261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health