Basic Information
Provider Information | |||||||||
NPI: | 1497733695 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VOORHEES | ||||||||
FirstName: | MARY BETH | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KNOWLES | ||||||||
OtherFirstName: | MARY BETH | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 47149 BUSE RD | ||||||||
Address2: | BLDG 1370 | ||||||||
City: | PATUXENT RIVER | ||||||||
State: | MD | ||||||||
PostalCode: | 206701540 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3013429503 | ||||||||
FaxNumber: | 3013424718 | ||||||||
Practice Location | |||||||||
Address1: | 47149 BUSE RD | ||||||||
Address2: | BLDG 1370 | ||||||||
City: | PATUXENT RIVER | ||||||||
State: | MD | ||||||||
PostalCode: | 206701540 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3013429503 | ||||||||
FaxNumber: | 3013424718 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/06/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 10056 | MD | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.