NPIMap

Organization Active NPI

Maryland Institute for Individual & Family Therapy

  • Clinical Psychologist
  • College Park, MD
National Provider Identifier
1124204854
Registry record updated Jan 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
01730 Issued in MD
Legal business name
MARYLAND INSTITUTE FOR INDIVIDUAL & FAMILY THERAPY
Practice address
7307 Baltimore Ave
Suite 208
College Park, MD 20740-3231
Phone
(301) 277-3250
Fax
(301) 927-8052
NPI assigned
Jan 11, 2008
Last updated
Jan 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David P Fago, PH.D.NPI 1659495885
Title
Director
Phone
(301) 277-3250

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 01730 MD Primary

Addresses

Primary practice location

7307 Baltimore Ave
Suite 208
College Park, MD 20740-3231

Mailing address

7307 Baltimore Ave
Suite 208
College Park, MD 20740-3231
Phone (301) 277-3250

Other names 1

  • Maryland Institute Other name

National Provider Directory

National Provider Directory

Locations

7307 Baltimore Ave
Ste 208
College Park, MD 20740
Phone (301) 277-2350

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200009600000",
    "number": "1124204854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7307 BALTIMORE AVE",
            "address_2": "SUITE 208",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207403231",
            "telephone_number": "301-277-3250",
            "fax_number": "301-927-8052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7307 BALTIMORE AVE",
            "address_2": "SUITE 208",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207403231",
            "telephone_number": "301-277-3250",
            "fax_number": "301-927-8052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND INSTITUTE FOR INDIVIDUAL & FAMILY THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-11",
        "last_updated": "2008-01-11",
        "status": "A",
        "authorized_official_last_name": "FAGO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "301-277-3250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "01730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maryland Institute",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in College Park, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.