Basic Information
| Provider Information | |||||||||
| NPI: | 1588218846 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT A. PASCAL YOUTH AND FAMILY SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 180 | ||||||||
| Address2: | |||||||||
| City: | ODENTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211130180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109750067 | ||||||||
| FaxNumber: | 4109750204 | ||||||||
| Practice Location | |||||||||
| Address1: | 43 COMMUNITY PL | ||||||||
| Address2: | |||||||||
| City: | CROWNSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210322034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105714500 | ||||||||
| FaxNumber: | 4109750204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2019 | ||||||||
| LastUpdateDate: | 09/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | LAMB | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 4109750067 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ROBERT A. PASCAL YOUTH AND FAMILY SERVICES, INC. | ||||||||
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| NPICertificationDate: | 09/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.