Organization
ERTA BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON KOGAN (DELEGATED OFFICIAL)
(443) 253-5533
Entity
Organization
Contact information
Practice address
7400 WILHELM DR, LANHAM, MD 20706-3725
(240) 501-2710
Mailing address
7400 WILHELM DR, LANHAM, MD 20706-3725
(240) 501-2710
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/24/2020
Last updated
06/17/2020
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