| Organization Name: | EASTERN SHORE PSYCHOLOGICAL SERVICES, LLC |
| NPI Number: | 1356798979 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CATHY K BURKHARD (ESPS BILLING SUPERVISOR & CREDENTIA) |
| Mailing Address: | 315 High St Ste 201 Chestertown |
| State: | MD US |
| Postal Code: | 216201350 |
| Phone Number: | 4103346961 |
| Fax Number: | |
| NPI Enumeration Date: | 05/24/2016 |
| NPI Last Update Date: | 05/24/2016 |
| 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: | |