Organization
MENTOR MARYLAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD MATRICARDI LCSW-C (STATE DIRECTOR)
(443) 543-2101
Entity
Organization
Contact information
Practice address
5720 EXECUTIVE DR, BALTIMORE, MD 21228-1757
(443) 543-2100
(443) 543-2110
Mailing address
5720 EXECUTIVE DR, BALTIMORE, MD 21228-1757
(443) 543-2100
(443) 543-2110
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
2012
MD
Other
Enumeration date
06/13/2006
Last updated
08/22/2020
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