| Mentor Maryland | |
|
5720 Executive Dr Baltimore MD 21228-1757 | |
| (443) 543-2100 | |
| (443) 543-2110 |
| Full Name | Mentor Maryland |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 5720 Executive Dr, Baltimore, Maryland |
| Authorized Official Name and Position | Edward Matricardi (STATE DIRECTOR) |
| Authorized Official Contact | 4435432101 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mentor Maryland 5720 Executive Dr Baltimore MD 21228-1757 Ph: (443) 543-2100 | Mentor Maryland 5720 Executive Dr Baltimore MD 21228-1757 Ph: (443) 543-2100 |
| NPI Number | 1518900364 |
|---|---|
| Provider Enumeration Date | 06/13/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518900364 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 2012 (Maryland) | Primary |
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