Provider Demographics
NPI:1962695643
Name:CAPITAL MENTAL HEALTH ASSOCIATES LLC
Entity type:Organization
Organization Name:CAPITAL MENTAL HEALTH ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-297-3449
Mailing Address - Street 1:14035 EDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:SMITHSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21783-1234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:431 DUAL HWY
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5713
Practice Address - Country:US
Practice Address - Phone:240-297-3449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00247852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2299444OtherCIGNA
MD07910001OtherCARE FIRST BLUE CROSS BLU
DC88924103OtherCARE FIRST BLUE CTOSS BLU
MDM575051OtherVALUE OPTIONS
MD1272217Medicaid
MD7417824OtherAETNA
MD779940OtherNCPPO
MD779940OtherNCPPO