Provider Demographics
NPI:1962287136
Name:PSYCHIATRY UTOPIA LLC
Entity type:Organization
Organization Name:PSYCHIATRY UTOPIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:BESERAT
Authorized Official - Middle Name:LEGESSE
Authorized Official - Last Name:KIBRET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-404-8147
Mailing Address - Street 1:2425 GEORGIA AVE APT 81
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902
Mailing Address - Country:US
Mailing Address - Phone:130-140-4814
Mailing Address - Fax:
Practice Address - Street 1:10400 CONNECTICUT AVE STE 311
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3942
Practice Address - Country:US
Practice Address - Phone:301-404-8147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)