Organization
PSYCHOGERIATRIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRIAM PERALES (CREDENTIALING MANAGER)
(240) 691-4952
Entity
Organization
Contact information
Practice address
12073 TECH RD STE B, SILVER SPRING, MD 20904-7874
(301) 593-1315
(301) 681-4699
Mailing address
12073 TECH RD STE B, SILVER SPRING, MD 20904-7874
(301) 593-1315
(301) 681-4699
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400730100
—
MD
01
—
G01132
MEDICARE
DC
Enumeration date
07/12/2006
Last updated
01/08/2024
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