DR. BRUKE TADESSE (NPI# 1306861752) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306861752 |
| Entity Type | Individual |
| Full Name | DR. BRUKE TADESSE |
| Practice Address |
3415 Hamilton St Ste 9 Hyattsville MD 20782 |
| Mailing Address |
3415 Hamilton St Ste 9 Hyattsville MD 20782-3953 |
| Practice Telephone | 3017792461 |
| Practice Fax Number | 3017796095 |
| Mailing Telephone | 3017792461 |
| Mailing Fax Number | 3017796095 |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2019-04-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
LC0295 | MD | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 1316126121 | 05 | |
| MD | 1093750697 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 16220 S Frederick Ave, Suite 422, Gaithersburg, MD 208774039 | 3019637222 | 3019632616 |
| 6 Montgomery Village Ave Ste 400, Gaithersburg, MD 208793548 | 3019637222 | 3019632616 |
| Street Address |
3415 HAMILTON ST STE 9 |
| City | HYATTSVILLE |
| State | MD |
| Zip Code | 20782 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124637863 | Samuel Woldemichael | Counselor | 3415 Hamilton St Ste 9, Hyattsville, MD 20782-3953 | 2020-07-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932712254 | Covenant Cosmetic & Wellness Center | Clinic/Center | 3415 Hamilton Street, Suite 5, Hyattsville, MD 20782 | 2020-08-26 |
| 1174146807 | Scort Achah | Home Health Aide | 2572 Queens Chapel Road, #4, Hyattsville, MD 20782 | 2020-05-28 |
| 1679130215 | Kla Vision, P.C. | Optometrist | 3500 East-west Highway, Hyattsville, MD 20782 | 2019-05-20 |
| 1417431677 | Visurraga Enterprises LLC | Nurse Anesthetist, Certified Registered | 4112 E West Hwy, Hyattsville, MD 20782 | 2018-09-24 |
| 1134605876 | Melinda Merricks | Behavioral Analyst | 5901 31st Ave, Apt. 203, Hyattsville, MD 20782 | 2018-07-16 |
| 1457849093 | Prince George's County Health Department | Clinic/Center | 7000 Adelphi Road, Hyattsville, MD 20782 | 2018-04-30 |
| 1922527134 | Amenan Marie Paule Yao | Home Health Aide | 7009 Highview Ter Apt 202, Hyattsville, MD 20782 | 2017-09-19 |
| 1558886358 | Emilia Domingez De Urena | Home Health Aide | 6700 Belcrest Road, Hyattsville, MD 20782 | 2017-08-14 |
| 1184176851 | Prince George's Hospital Center | Student in an Organized Health Care Education/Training Program | 3500 Dean Drive, Apt K3, Hyattsville, MD 20782 | 2016-10-28 |
| 1992257927 | Johanna Arias-bonilla | Social Worker | 2970 Belcrest Center Drive Unit 301, Hyattsville, MD 20782 | 2016-10-25 |
| Find all providers in zip 20782 | ||||
| Taxonomy Code | 103TA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356977268 | Gift 2 Uplift 2 Inc | Psychologist | 3325 Prince Edward Dr, White Plains, MD 20695-3448 | 2020-03-23 |
| 1518599679 | Gemini Health Holdings LLC | Psychologist | 1704 Back Acre Cir, Mount Airy, MD 21771-7768 | 2020-02-06 |
| 1225677883 | Md Counseling Services LLC | Psychologist | 924 E Baltimore St Ste 204, Baltimore, MD 21202-4736 | 2019-12-31 |
| 1659815587 | Eddie Freeman | Psychologist | 880 W Lombard St, Baltimore, MD 21201-1057 | 2016-12-12 |
| 1699012252 | Murugi Wa Mungai | Psychologist | 4914 Good Hours Pl, Columbia, MD 21044-1508 | 2013-01-15 |
| 1265716138 | Towson Addictions Center | Psychologist | 102 W Pennsylvania Ave Ste 306, Towson, MD 21204-4543 | 2011-10-10 |
| 1710284344 | Emily Massey | Psychologist | 222 Courthouse Ct, Suite 2d, Towson, MD 21204-1828 | 2011-02-17 |
| 1427292507 | North Baltimore Center, Inc | Psychologist | 2225 N Charles Steet, Baltimore City, MD 21218 | 2009-04-21 |
| 1750559654 | Sheila Mary Harron | Psychologist | 8901 New Hampshire Ave, Silver Spring, MD 20903-3611 | 2008-02-13 |
| 1700931177 | Insight Treatment Services | Psychologist | 4920 Niagara Rd, Ste 101, College Park, MD 20740-1110 | 2007-01-24 |
| Find all providers with the same taxonomy | ||||
| City | HYATTSVILLE |
| Zip Code | 20782 |
Please comment or provide details below to improve the information on DR. BRUKE TADESSE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.