Basic Information
| Provider Information | |||||||||
| NPI: | 1568808012 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERDYANMICS,INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 FORBES BLVD | ||||||||
| Address2: | |||||||||
| City: | LANHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207064807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013064590 | ||||||||
| FaxNumber: | 3013064591 | ||||||||
| Practice Location | |||||||||
| Address1: | 4601 FORBES BLVD | ||||||||
| Address2: | SUITE #100 | ||||||||
| City: | LANHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207064807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013064590 | ||||||||
| FaxNumber: | 3013064591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2013 | ||||||||
| LastUpdateDate: | 05/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | MITCHELL | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE PROJECT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3013064590 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 18189 | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.