Basic Information
| Provider Information | |||||||||
| NPI: | 1538640057 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEFUNA MENTAL HEALTH WELLNESS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7474 GREENWAY CENTER DR STE 700A | ||||||||
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| City: | GREENBELT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207703523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019823437 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1003 W 7TH ST STE 200 | ||||||||
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| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217014106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012456300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2018 | ||||||||
| LastUpdateDate: | 08/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | REIDY | ||||||||
| AuthorizedOfficialFirstName: | CAROLYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANGER | ||||||||
| AuthorizedOfficialTelephone: | 8455903230 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEFUNA MENTAL HEALTH WELLNESS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | D66576 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.