Mid Atlantic Neuropsychology LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

Legal business name

MID ATLANTIC NEUROPSYCHOLOGY LLC

Practice address

1501 Sulgrave Ave Ste 209
Baltimore, MD 21209-3650

Phone

(410) 205-9820

NPI assigned

Dec 10, 2018

Organization subpart

No

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

Authorized official

Name

Jacob Priluck, PSYD

Title

President

Phone

(410) 205-9820

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1544400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673481600000",
    "number": "1245701713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 SULGRAVE AVE STE 209",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093650",
            "telephone_number": "410-205-9820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SULGRAVE AVE STE 209",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093650",
            "telephone_number": "410-205-9820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2311 Hanway Rd",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212092601",
            "country_code": "US",
            "telephone_number": "917-783-0634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MID ATLANTIC NEUROPSYCHOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-10",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A",
        "authorized_official_last_name": "PRILUCK",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-205-9820",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Miciche, CRNP
• Diane Lyn Mick, OTR/L
• Ania Mickens
• Shaylah Mickens
• Ladinah Micthell
• Mid Atlantic Trauma Recovery Center, LLC
• Mid-Atlantic Glaucoma Experts, LLC
• Mid-Atlantic Nephrology Associates PA
• Mid-Atlantic Nephrology Associates PA
• Mid-Atlantic Nephrology Associates PA

• Clinical Neuropsychologist in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Clinical Neuropsychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; 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.