Provider Demographics
NPI:1396802567
Name:TOWN CENTER PSYCHIATRIC ASSOC
Entity type:Organization
Organization Name:TOWN CENTER PSYCHIATRIC ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-953-1266
Mailing Address - Street 1:208 MONROE STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-309-8200
Mailing Address - Fax:301-309-9667
Practice Address - Street 1:208 MONROE STREET
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-309-8200
Practice Address - Fax:301-309-9667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
901531Medicare PIN