# CPE CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104274547
- **Authorized official:** DR. MICHAEL JOHN LABELLARTE SR. M.D. (PRINCIPLE)
- **Authorized official phone:** (410) 979-2326

## Contact information

- **Practice address:** 711 W 40TH ST, 428, BALTIMORE, MD 21211-2120
- **Practice address phone:** (410) 979-2326
- **Practice address fax:** (877) 979-2327
- **Mailing address:** 711 W 40TH ST, 428, BALTIMORE, MD 21211-2120
- **Mailing address phone:** (410) 979-2326
- **Mailing address fax:** (877) 979-2327

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/26/2016
- **Last updated:** 05/26/2016