| Mentor-maryland | |
|
5970 Frederick Crossing Lane #202 Frederick MD 21704 | |
| (301) 524-0977 | |
| Not Available |
| Full Name | Mentor-maryland |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5970 Frederick Crossing Lane, Frederick, Maryland |
| Authorized Official Name and Position | Carol Ivy Simmons (DIRECTOR, OMHC) |
| Authorized Official Contact | 4104554600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mentor-maryland 5720 Executive Drive Catonsville MD 21228 Ph: (410) 455-4600 | Mentor-maryland 5970 Frederick Crossing Lane #202 Frederick MD 21704 Ph: (301) 524-0977 |
| NPI Number | 1104352368 |
|---|---|
| Provider Enumeration Date | 05/10/2017 |
| Last Update Date | 05/10/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104352368 | NPI | - | NPPES |
| 056668 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MH-2279 (Maryland) | Primary |
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