| Uncaged Potential Llc | |
|
703 Dale Ave Baltimore MD 21206 | |
| (410) 929-1101 | |
| (410) 522-1181 |
| Full Name | Uncaged Potential Llc |
|---|---|
| Speciality | Social Worker |
| Location | 703 Dale Ave, Baltimore, Maryland |
| Authorized Official Name and Position | Jeffrey Aviles (OWNER) |
| Authorized Official Contact | 4109291101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Uncaged Potential Llc 703 Dale Ave Baltimore MD 21206 Ph: (410) 929-1101 | Uncaged Potential Llc 703 Dale Ave Baltimore MD 21206 Ph: (410) 929-1101 |
| NPI Number | 1225754831 |
|---|---|
| Provider Enumeration Date | 10/14/2022 |
| Last Update Date | 05/09/2024 |
| Certification Date | 03/12/2024 |
| Medicare PECOS PAC ID | 9537500194 |
|---|---|
| Medicare Enrollment ID | O20240514000934 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225754831 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jeffrey Aviles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659726834 PECOS PAC ID: 9133403769 Enrollment ID: I20170228000301 |
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