Organization
SUPPORTIVE CARE OF MARYLAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAPHAEL LICHTSCHEIN (OWNERR)
(718) 506-1115
Entity
Organization
Contact information
Practice address
4409 E WEST HWY, RIVERDALE, MD 20737-1058
(718) 298-4375
Mailing address
27 RANDOLPH RD, HOWELL, NJ 07731-8611
(718) 298-4375
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
07/09/2019
Last updated
07/09/2019
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