Organization
ACTIVISION FIDELITY PSYCHIATRIC MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNY AMANZE CRNP-PMH (PRESIDENT)
(301) 907-1199
Entity
Organization
Contact information
Practice address
2409 BAIKAL LOOP, UPPER MARLBORO, MD 20774-7051
(301) 907-1199
(240) 342-3440
Mailing address
2409 BAIKAL LOOP, UPPER MARLBORO, MD 20774-7051
(301) 907-1199
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/10/2023
Last updated
04/09/2026
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