NPIMap

Organization Active NPI

Petra Therapeutic Group LLC

  • Clinical Social Worker
  • Lanham, MD
National Provider Identifier
1447636386
Registry record updated Aug 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
17942 Issued in MD
Legal business name
PETRA THERAPEUTIC GROUP LLC
Doing business as
Petra Therapeutic
Practice address
9332 Annapolis Rd Ste 304
Lanham, MD 20706-3168
Phone
(301) 731-2823
Fax
(301) 731-2833
NPI assigned
Aug 3, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2015

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

Authorized official

Name
Mr. Darryl Marshall Sr., LCSW-C
Title
Owner
Phone
(301) 731-2823

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 17942 MD Primary

Addresses

Primary practice location

9332 Annapolis Rd Ste 304
Lanham, MD 20706-3168

Mailing address

9332 Annapolis Rd Ste 304
Lanham, MD 20706-3168
Phone (301) 731-2823

Other names 1

  • Petra Therapeutic Doing business as

National Provider Directory

National Provider Directory

Locations

9332 Annapolis Rd
Bldg Llc
Lanham, MD 20706
Phone (301) 731-2823

NPI Registry JSON

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

{
    "created_epoch": "1438560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438560000000",
    "number": "1447636386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9332 ANNAPOLIS RD STE 304",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207063168",
            "telephone_number": "301-731-2823",
            "fax_number": "301-731-2833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9332 ANNAPOLIS RD STE 304",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207063168",
            "telephone_number": "301-731-2823",
            "fax_number": "301-731-2833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETRA THERAPEUTIC GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-03",
        "last_updated": "2015-08-03",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-731-2823",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "17942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Petra Therapeutic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lanham, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2015; 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.