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Organization

MEDITELECARE OF MARYLAND LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANDREA GODFREY (CREDENTIALING & ENROLLMENT MANAGER)
(860) 398-6441
Entity
Organization

Contact information

Practice address
7 SAINT PAUL ST STE 820, BALTIMORE, MD 21202-1681
(860) 788-6404
(860) 829-0495
Mailing address
PO BOX 1595, MIDDLETOWN, CT 06457-8095
(860) 788-6404
(860) 829-0495

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
103TC0700X
Clinical Psychologist
104100000X
Social Worker
1041C0700X
Clinical Social Worker
2084N0400X
Neurology Physician
2084P0800X
Psychiatry Physician
363L00000X
Nurse Practitioner
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Enumeration date
04/28/2021
Last updated
05/16/2025
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