Core Clinical Services | |
9475 Deereco Rd Suite 410 Timonium MD 21093-2118 | |
(410) 560-6135 | |
(410) 560-6136 |
Full Name | Core Clinical Services |
---|---|
Speciality | Psychologist |
Location | 9475 Deereco Rd, Timonium, Maryland |
Authorized Official Name and Position | Marquerite Petranella Laban (OWNER) |
Authorized Official Contact | 4103717187 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Core Clinical Services 9475 Deereco Rd Suite 410 Timonium MD 21093-2118 Ph: (410) 560-6135 | Core Clinical Services 9475 Deereco Rd Suite 410 Timonium MD 21093-2118 Ph: (410) 560-6135 |
NPI Number | 1649656943 |
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Provider Enumeration Date | 08/10/2015 |
Last Update Date | 08/08/2023 |
Certification Date | 08/08/2023 |
Medicare PECOS PAC ID | 8123385333 |
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Medicare Enrollment ID | O20171127000746 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649656943 | NPI | - | NPPES |
717002500 | Medicaid | MD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | 05420 (Maryland) | Primary |
Provider Name | Marquerite Petranella Laban |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1659472090 PECOS PAC ID: 3476778424 Enrollment ID: I20140707001059 |
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