Provider Demographics
NPI:1548081854
Name:GENESIS MENTAL HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:GENESIS MENTAL HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:BESEM
Authorized Official - Last Name:TAKOR
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMHNP
Authorized Official - Phone:240-899-2683
Mailing Address - Street 1:6340 SECURITY BLVD # 100-A38
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5173
Mailing Address - Country:US
Mailing Address - Phone:240-899-2683
Mailing Address - Fax:
Practice Address - Street 1:6340 SECURITY BLVD # 100-A38
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:MD
Practice Address - Zip Code:21207-5173
Practice Address - Country:US
Practice Address - Phone:240-899-2683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty