Provider Demographics
NPI:1285447508
Name:PM KIDS
Entity type:Organization
Organization Name:PM KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALI
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-585-7128
Mailing Address - Street 1:4225 ALTAMONT PL STE 201
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3065
Mailing Address - Country:US
Mailing Address - Phone:240-585-7128
Mailing Address - Fax:
Practice Address - Street 1:4225 ALTAMONT PL STE 201
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3065
Practice Address - Country:US
Practice Address - Phone:240-585-7128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PM KIDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst