Full Name | |
---|---|
Speciality | Counselor - Mental Health |
Location | 12 2nd Ave, Brooklyn, Maryland |
Authorized Official Name and Position | Thomas Jose (DIRECTOR) |
Authorized Official Contact | 4106090022 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
12 2nd Ave Brooklyn MD 21225-2711 Ph: (410) 609-0022 | 12 2nd Ave Brooklyn MD 21225-2711 Ph: (410) 609-0022 |
NPI Number | 1750689162 |
---|---|
Provider Enumeration Date | 03/09/2011 |
Last Update Date | 03/09/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1750689162 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | 540075900 (Maryland) | Primary |
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