Basic Information
| Provider Information | |||||||||
| NPI: | 1760925978 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIORAL HEALTH PARTNERS - FPCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 SOLAREX CT | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217038624 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6501 N CHARLES ST | ||||||||
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| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212046819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109383154 | ||||||||
| FaxNumber: | 4109383159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2016 | ||||||||
| LastUpdateDate: | 11/21/2016 | ||||||||
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| AuthorizedOfficialLastName: | KATZ | ||||||||
| AuthorizedOfficialFirstName: | BONNIE | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OPERATIONS & BUSINESS DEVELOP. | ||||||||
| AuthorizedOfficialTelephone: | 4109383154 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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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.