Provider Demographics
NPI:1528280302
Name:THE LOYOLA CLINICAL CENTERS
Entity type:Organization
Organization Name:THE LOYOLA CLINICAL CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BHAS
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:COIRO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-617-1200
Mailing Address - Street 1:5911 YORK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3048
Mailing Address - Country:US
Mailing Address - Phone:410-617-1200
Mailing Address - Fax:410-617-1203
Practice Address - Street 1:5911 YORK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3048
Practice Address - Country:US
Practice Address - Phone:410-617-1200
Practice Address - Fax:410-617-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3580103T00000X
MD3251103T00000X
MD3823103T00000X
MD4348103T00000X
MD3352103T00000X
MD3543103T00000X
MD4025103T00000X
MD2865103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty