Basic Information
Provider Information | |||||||||
NPI: | 1174821441 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | WORCESTER COUNTY HEALTH DEPARTMENT | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MENTAL HEALTH | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | P.O. BOX 249 | ||||||||
Address2: | 6040 PUBLIC LANDING RAOD | ||||||||
City: | SNOW HILL | ||||||||
State: | MD | ||||||||
PostalCode: | 218630249 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4106321100 | ||||||||
FaxNumber: | 4106322476 | ||||||||
Practice Location | |||||||||
Address1: | 400 WALNUT STREET | ||||||||
Address2: | SUITE A | ||||||||
City: | POCOMOKE | ||||||||
State: | MD | ||||||||
PostalCode: | 218511501 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4109572005 | ||||||||
FaxNumber: | 4109572417 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/10/2011 | ||||||||
LastUpdateDate: | 07/23/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BARTON | ||||||||
AuthorizedOfficialFirstName: | HEATHER | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF ADMIN | ||||||||
AuthorizedOfficialTelephone: | 4106321100 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | MH556 | MD | Y |   | Agencies | Community/Behavioral Health |   |
No ID Information.