| Freestate Behavioral Health Associates Llc | |
|
3455 Wilkens Ave Ste 301 Baltimore MD 21229-5214 | |
| (443) 695-7851 | |
| Not Available |
| Full Name | Freestate Behavioral Health Associates Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3455 Wilkens Ave Ste 301, Baltimore, Maryland |
| Authorized Official Name and Position | Dwight A Polk (OWNER) |
| Authorized Official Contact | 4436957851 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Freestate Behavioral Health Associates Llc 3455 Wilkens Ave Ste 301 Baltimore MD 21229-5214 Ph: (443) 695-7851 | Freestate Behavioral Health Associates Llc 3455 Wilkens Ave Ste 301 Baltimore MD 21229-5214 Ph: (443) 695-7851 |
| NPI Number | 1487155776 |
|---|---|
| Provider Enumeration Date | 02/22/2018 |
| Last Update Date | 02/22/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487155776 | NPI | - | NPPES |
| 601222437 | Other | MD | MAGELLAN ID # |
| CR20-0007 | Other | MD | CAREFIRST BCBS |
| 6018524 | Other | MD | AETNA PIN # |
| 1356866768 | Other | MD | TYPE 1 INDIVIDUAL NPI # |
| 338300 | Other | MD | JHHC ID # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 18559 (Maryland) | Primary |
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