Basic Information
Provider Information | |||||||||
NPI: | 1003035858 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | WORCESTER COUNTY HEALTH DEPARTMENT | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MENTAL HEALTH PROGRAM | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | P.O. BOX 249 | ||||||||
Address2: |   | ||||||||
City: | SNOW HILL | ||||||||
State: | MD | ||||||||
PostalCode: | 21863 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4106321100 | ||||||||
FaxNumber: | 4106322476 | ||||||||
Practice Location | |||||||||
Address1: | WORCESTER COUNTY HEALTH DEPT. - MENTAL HEALTH PROGRAM | ||||||||
Address2: | 6040 PUBLIC LANDING ROAD | ||||||||
City: | SNOW HILL | ||||||||
State: | MD | ||||||||
PostalCode: | 21863 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4106321100 | ||||||||
FaxNumber: | 4106322476 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/24/2007 | ||||||||
LastUpdateDate: | 08/14/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BARTON | ||||||||
AuthorizedOfficialFirstName: | HEATHER | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIR OF ADMIN SERVICE | ||||||||
AuthorizedOfficialTelephone: | 4106321100 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X |   | MD | N |   | Agencies | Public Health or Welfare |   | 251S00000X | MH-554 | MD | Y |   | Agencies | Community/Behavioral Health |   |
ID Information
ID | Type | State | Issuer | Description | 265081902 | 05 | MD |   | MEDICAID |