| The Mandala Center: Behavioral Health & Wellness | |
|
540 E. Belvedere Avenue Suite 203 Baltimore MD 21212 | |
| (410) 591-5380 | |
| Not Available |
| Full Name | The Mandala Center: Behavioral Health & Wellness |
|---|---|
| Speciality | Psychologist |
| Location | 540 E. Belvedere Avenue, Baltimore, Maryland |
| Authorized Official Name and Position | Cathryne L Maciolek (PRINCIPAL) |
| Authorized Official Contact | 4105915380 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Mandala Center: Behavioral Health & Wellness 540 E Belvedere Ave Suite 203 Baltimore MD 21212-3750 Ph: (410) 591-5380 | The Mandala Center: Behavioral Health & Wellness 540 E. Belvedere Avenue Suite 203 Baltimore MD 21212 Ph: (410) 591-5380 |
| NPI Number | 1053703298 |
|---|---|
| Provider Enumeration Date | 02/25/2015 |
| Last Update Date | 12/02/2015 |
| Medicare PECOS PAC ID | 7113243460 |
|---|---|
| Medicare Enrollment ID | O20150303001696 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053703298 | NPI | - | NPPES |
| 393635 | Other | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 05298 (Maryland) | Primary |
| Provider Name | Richard A Koch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255363248 PECOS PAC ID: 3870483290 Enrollment ID: I20040318001185 |
| Provider Name | Claude B Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619929676 PECOS PAC ID: 5092907212 Enrollment ID: I20101006000973 |
| Provider Name | Maria T Slodzinski |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750554903 PECOS PAC ID: 0840474193 Enrollment ID: I20110411000507 |
| Provider Name | Cathryne L Maciolek Waugh |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689815235 PECOS PAC ID: 0446403018 Enrollment ID: I20130109000644 |
| Provider Name | Lauren A Bynum |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457530438 PECOS PAC ID: 6800073081 Enrollment ID: I20131111001289 |
| Provider Name | Julie Solomon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891195509 PECOS PAC ID: 8921320995 Enrollment ID: I20151012001955 |
| Provider Name | Patricia Farrell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104355841 PECOS PAC ID: 3678844065 Enrollment ID: I20170803000774 |
| Provider Name | Catherine M Graves |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912473968 PECOS PAC ID: 8022352574 Enrollment ID: I20181210003083 |
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