Organization Name: | EASTERN SHORE PSYCHOLOGICAL SERVICES, LLC |
NPI Number: | 1235226952 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY KATHYRN SEIFERT (EXECUTIVE DIRECTOR CEO) |
Mailing Address: | 11120 Somerset Ave Princess Anne |
State: | MD US |
Postal Code: | 218532970 |
Phone Number: | 4106514200 |
Fax Number: | 4106514291 |
NPI Enumeration Date: | 10/06/2006 |
NPI Last Update Date: | 08/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |