Facility Program Codes
Outpatient Therapy for an adult with anxiety
CPA or OPA
90837
Psychotherapy 60 mins
MD000015132
1629057773, Brenda Widemuth
Registered Nurse
Parent Code
MDH
Inpatient Psychiatric Services for an Adolescent
APL
90791
Psychiatric Diagnostic Eval w/out medical services
Patricia James DOB 3/3/1980
FDUA
1275782138, Tamara Baker
PhD - Psychologist
64
PHP for Substance Use for someone aged 71
PCG
90853 GT
Group psychotherapy, telehealth
MD000015479
SBTP
1477068187, Kidian Martinez
LCSW
Association Codes
MDHM, MDHN
IOP for Eating Disorder in Adolescents
IEL
H2018 UB, POS of 52
Psychosocial Rehabilitation Services
MD000015228
SSX0
1649841487, Angela Chen
BCBA - Board Certified Behavioral Analyst
Program Hours of Operation
8 AM - 6 PM EST
Inpatient detox for alcohol use for an adult
ADA
96130 GT
Psychological Testing, Telehealth (NOT allowed as a service)
Tim Rana DOB 12/3/1983
FMCO/MDIN
1265780050, Ashleigh Cicconi
LCAT, Licensed Certified Art Therapist
What state is this Medicaid program for?
Maryland