Basics Group Practice, LLC
Organization Active NPI Clinical Psychologist · Forestville, MD
NPI 1134486079 · NPPES record last updated Apr 17, 2012
Key facts
- NPI
- 1134486079
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 04481 (MD)
- Legal business name
- BASICS GROUP PRACTICE, LLC
- Practice address
- 7610 Pennsylvania Ave
Suite #203
Forestville, MD 20747-4701 - Phone
- (301) 420-1972
- Fax
- (301) 420-1973
- NPI assigned
- Apr 17, 2012
- Organization subpart
- No
Authorized official
- Name
- Daniel N Ferebee
- Title
- Ceo
- Phone
- (301) 420-1972
Corporate family (same tax ID) 3
National Provider Directory
- Tax ID family
- Basics Group Practice LLC
Locations
7610 Pennsylvania Ave
Ste 203
Forestville, MD 20747
Phone (301) 420-1972
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | 04481 | MD | Yes |
Addresses
Primary practice location
7610 Pennsylvania Ave
Suite #203
Forestville, MD 20747-4701
Mailing address
7610 Pennsylvania Ave
Suite #203
Forestville, MD 20747-4701
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 417682100 | Medicaid | MD | |
| 036596300 | Medicaid | MD | |
| 417682101 | Medicaid | MD |
Other providers in Forestville, MD
- Floyd Bagwell
- Blake Ariel Banner
- Meikel Barnes
- Basics Counseling Services LLC
- Basics Group Practice LLC
- Nichole Blackmon
- Cassidy Blake
- Neh Bouesela
- Tarisa Brinson
- Candace Brown
All providers in Forestville, MD · Clinical Psychologist in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.