Provider Demographics
NPI:1194276279
Name:HOWARD COUNTY PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:HOWARD COUNTY PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER, LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDITCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:410-629-9256
Mailing Address - Street 1:5116 DORSEY HALL DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7871
Mailing Address - Country:US
Mailing Address - Phone:410-995-8274
Mailing Address - Fax:
Practice Address - Street 1:5116 DORSEY HALL DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7871
Practice Address - Country:US
Practice Address - Phone:410-995-8274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05683103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty