| San Mar Children's Home | |
|
8504 Mapleville Road Boonsboro MD 21713 | |
| (301) 733-9067 | |
| Not Available |
| Full Name | San Mar Children's Home |
|---|---|
| Speciality | Social Worker |
| Location | 8504 Mapleville Road, Boonsboro, Maryland |
| Authorized Official Name and Position | Keith Fanjoy (CEO) |
| Authorized Official Contact | 3017339067 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Mar Children's Home 8504 Mapleville Road Boonsboro MD 21713 Ph: () - | San Mar Children's Home 8504 Mapleville Road Boonsboro MD 21713 Ph: (301) 733-9067 |
| NPI Number | 1659739720 |
|---|---|
| Provider Enumeration Date | 02/04/2016 |
| Last Update Date | 04/11/2022 |
| Certification Date | 04/11/2022 |
| Medicare PECOS PAC ID | 4688951254 |
|---|---|
| Medicare Enrollment ID | O20170509000559 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659739720 | NPI | - | NPPES |
| Provider Name | Melissa A Phillips |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023164829 PECOS PAC ID: 4183619638 Enrollment ID: I20040415000772 |
| Provider Name | Ira S Lourie |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174549992 PECOS PAC ID: 8325272404 Enrollment ID: I20171228002832 |
| Provider Name | Debra Ambrose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518193416 PECOS PAC ID: 5991858615 Enrollment ID: I20190522003014 |
| Provider Name | Meghan L Runey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972116143 PECOS PAC ID: 0345651220 Enrollment ID: I20201125000604 |
| Provider Name | Jerica M Washington |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427413665 PECOS PAC ID: 3870834534 Enrollment ID: I20220430000069 |
| Provider Name | Sally Jornlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851918429 PECOS PAC ID: 3971980822 Enrollment ID: I20220513001553 |
| Provider Name | Erica R Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306341052 PECOS PAC ID: 3173995305 Enrollment ID: I20230215002558 |
| Provider Name | Jessica Brangaccio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770174641 PECOS PAC ID: 6204208432 Enrollment ID: I20230215002745 |
| Provider Name | Mary B. Choudhary |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164948006 PECOS PAC ID: 9739552431 Enrollment ID: I20230228001304 |
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