| Mahogany Wellness | |
|
3108 Bayonne Ave Baltimore MD 21214-2323 | |
| (443) 743-7777 | |
| Not Available |
| Full Name | Mahogany Wellness |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3108 Bayonne Ave, Baltimore, Maryland |
| Authorized Official Name and Position | Stacie Harrison (PSYCHIATRIC NURSE PRACTITIONER) |
| Authorized Official Contact | 4437437777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mahogany Wellness 9613 Harford Rd Ste C Baltimore MD 21234-2150 Ph: (443) 743-7777 | Mahogany Wellness 3108 Bayonne Ave Baltimore MD 21214-2323 Ph: (443) 743-7777 |
| NPI Number | 1073207171 |
|---|---|
| Provider Enumeration Date | 06/05/2023 |
| Last Update Date | 04/12/2024 |
| Certification Date | 04/12/2024 |
| Medicare PECOS PAC ID | 0547608192 |
|---|---|
| Medicare Enrollment ID | O20240402003435 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073207171 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Stacie Nicole Harrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811280803 PECOS PAC ID: 5597123802 Enrollment ID: I20230620000130 |
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