Individual
OLIVIA MEDOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
903 BRIGHTSEAT RD, LANDOVER, MD 20785-4725
(301) 333-2980
Mailing address
903 BRIGHTSEAT RD, LANDOVER, MD 20785-4725
(301) 333-2980
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
2872
MD
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336470384
—
MD
Enumeration date
09/17/2020
Last updated
09/17/2020
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