Organization
MENDELIS MENTAL HEALTH CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER S MENDELIS MD (OWNER)
(301) 638-5001
Entity
Organization
Contact information
Practice address
11315 PEMBROOKE SQ STE 112, WALDORF, MD 20603-4806
(301) 638-5001
(301) 638-5003
Mailing address
11315 PEMBROOKE SQ STE 112, WALDORF, MD 20603-4806
(301) 638-5001
(301) 638-5003
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
12909
MD
2084P0800X
Psychiatry Physician
Primary
D0025586
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
546610500
—
MD
05
—
950006501
—
MD
Enumeration date
10/06/2006
Last updated
11/15/2011
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