Provider Demographics
NPI:1598582850
Name:GREEN DOOR FAMILY PSYCHIATRY LLC
Entity type:Organization
Organization Name:GREEN DOOR FAMILY PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANEYFELT-JARZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:410-652-6701
Mailing Address - Street 1:1622 HARKINS RD
Mailing Address - Street 2:
Mailing Address - City:PYLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21132-1623
Mailing Address - Country:US
Mailing Address - Phone:410-652-6701
Mailing Address - Fax:
Practice Address - Street 1:604 MOORES MILL RD STE B
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2726
Practice Address - Country:US
Practice Address - Phone:410-652-6701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)