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2120 Emmorton Park Rd Ste E Edgewood MD 21040-1066 | |
| (443) 402-1925 | |
| (213) 289-8532 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 2120 Emmorton Park Rd Ste E, Edgewood, Maryland |
| Authorized Official Name and Position | Alana O'neill (PRESIDENT) |
| Authorized Official Contact | 4434021925 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
622 Dembytown Rd Joppa MD 21085-4111 Ph: (202) 838-7186 | 2120 Emmorton Park Rd Ste E Edgewood MD 21040-1066 Ph: (443) 402-1925 |
| NPI Number | 1699559179 |
|---|---|
| Provider Enumeration Date | 08/24/2023 |
| Last Update Date | 11/21/2024 |
| Certification Date | 11/21/2024 |
| Medicare PECOS PAC ID | 9739620717 |
|---|---|
| Medicare Enrollment ID | O20240918000057 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699559179 | NPI | - | NPPES |
| Provider Name | Lynda Boegner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023699402 PECOS PAC ID: 6406258607 Enrollment ID: I20210712000276 |
| Provider Name | Danielle Rongione |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942601307 PECOS PAC ID: 2567808694 Enrollment ID: I20240312002627 |
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