Provider Demographics
NPI:1871744946
Name:PSYCHOTHERAPEUTIC SERVICES OF SOUTHERN MARYLAND
Entity type:Organization
Organization Name:PSYCHOTHERAPEUTIC SERVICES OF SOUTHERN MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CASE MANAGEMENT PROGRAM
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-571-6645
Mailing Address - Street 1:41900 FENWICK ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650
Mailing Address - Country:US
Mailing Address - Phone:301-475-9315
Mailing Address - Fax:301-475-9317
Practice Address - Street 1:41900 FENWICK ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3813
Practice Address - Country:US
Practice Address - Phone:301-475-9315
Practice Address - Fax:301-475-9317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management