| Organization Name: | MARYLAND INSTITUTE FOR INDIVIDUAL & FAMILY THERAPY |
| NPI Number: | 1124204854 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID P FAGO (DIRECTOR) |
| Mailing Address: | 7307 Baltimore Ave Suite 208 College Park |
| State: | MD US |
| Postal Code: | 207403231 |
| Phone Number: | 3012773250 |
| Fax Number: | 3019278052 |
| NPI Enumeration Date: | 01/11/2008 |
| NPI Last Update Date: | 01/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 01730 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |