Organization
INTERVALS, INC.
Active
Organization
INTERVALS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY LANE (CONTROLLER)
(410) 358-5252
Entity
Organization
Contact information
Practice address
4814 SETON DR, BALTIMORE, MD 21215-3210
(410) 358-6400
(410) 358-6555
Mailing address
4814 SETON DR, BALTIMORE, MD 21215-3210
(410) 358-6400
(410) 358-6555
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
Other
Enumeration date
11/29/2006
Last updated
08/22/2020
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