| Innovative Behavioral Medicine Llc | |
|
801 Wayne Ave Ste G100 Silver Spring MD 20910-4493 | |
| (301) 615-8752 | |
| (240) 660-5460 |
| Full Name | Innovative Behavioral Medicine Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 801 Wayne Ave Ste G100, Silver Spring, Maryland |
| Authorized Official Name and Position | Christopher J Goisse (PSYCHIATRIC MENTAL HEALTH NP) |
| Authorized Official Contact | 3016158752 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Behavioral Medicine Llc 801 Wayne Ave Ste G100 Silver Spring MD 20910-4493 Ph: (301) 615-8752 | Innovative Behavioral Medicine Llc 801 Wayne Ave Ste G100 Silver Spring MD 20910-4493 Ph: (301) 615-8752 |
| NPI Number | 1043853740 |
|---|---|
| Provider Enumeration Date | 10/25/2019 |
| Last Update Date | 12/10/2021 |
| Certification Date | 12/10/2021 |
| Medicare PECOS PAC ID | 4284060302 |
|---|---|
| Medicare Enrollment ID | O20200210002140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043853740 | NPI | - | NPPES |
| 778129600 | Medicaid | MD |
| Provider Name | Christopher J Goisse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316432172 PECOS PAC ID: 5193151215 Enrollment ID: I20200210002269 |
| Provider Name | Angel Vivian Mbome |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811250905 PECOS PAC ID: 3072944297 Enrollment ID: I20200504000083 |
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