Organization
MID ATLANTIC NEUROPSYCHOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB PRILUCK PSYD (PRESIDENT)
(410) 205-9820
Entity
Organization
Contact information
Practice address
1501 SULGRAVE AVE STE 209, BALTIMORE, MD 21209-3650
(410) 205-9820
Mailing address
1501 SULGRAVE AVE STE 209, BALTIMORE, MD 21209-3650
(410) 205-9820
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
Other
Enumeration date
12/10/2018
Last updated
01/12/2023
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