NPIMap

Organization Active NPI

Integrative Therapy Center of Maryland, LLC

  • Psychologist
  • Baltimore, MD
National Provider Identifier
1245795103
Registry record updated Feb 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
INTEGRATIVE THERAPY CENTER OF MARYLAND, LLC
Practice address
1501 Sulgrave Ave Ste 205
Baltimore, MD 21209-3650
Phone
(414) 213-9636
NPI assigned
Feb 5, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2019

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

Authorized official

Name
Dr. Moshe Miller, PSYDNPI 1497284814
Title
Owner
Phone
(414) 213-9636

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X

Addresses

Primary practice location

1501 Sulgrave Ave Ste 205
Baltimore, MD 21209-3650

Mailing address

2810 Hanson Ave
Baltimore, MD 21209-3912

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1549324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549324800000",
    "number": "1245795103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 HANSON AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SULGRAVE AVE STE 205",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093650",
            "telephone_number": "414-213-9636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE THERAPY CENTER OF MARYLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-05",
        "last_updated": "2019-02-05",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MOSHE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-213-9636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; 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.