Organization
MENTOR MD
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
4501 FORBES BLVD, SUITE 140, LANHAM, MD 20706-4326
(301) 459-3057
(301) 731-3142
Mailing address
4501 FORBES BLVD, SUITE 140, LANHAM, MD 20706-4326
(301) 459-3057
(301) 731-3142
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
2012
MD
Other
Enumeration date
06/17/2006
Last updated
08/22/2020
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