| Mental Health Provider | |
|
22 W Padonia Rd Ste A203 Lutherville Timonium MD 21093-2277 | |
| (443) 475-0338 | |
| Not Available |
| Full Name | Mental Health Provider |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 22 W Padonia Rd Ste A203, Lutherville Timonium, Maryland |
| Authorized Official Name and Position | Aldin Gordon (MENTAL HEALTH PROVIDER) |
| Authorized Official Contact | 4104750338 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mental Health Provider 22 W Padonia Rd Ste A203 Lutherville Timonium MD 21093-2277 Ph: (443) 475-0338 | Mental Health Provider 22 W Padonia Rd Ste A203 Lutherville Timonium MD 21093-2277 Ph: (443) 475-0338 |
| NPI Number | 1396242152 |
|---|---|
| Provider Enumeration Date | 04/09/2018 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396242152 | NPI | - | NPPES |
| 086022100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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