Basic Information
| Provider Information | |||||||||
| NPI: | 1790249365 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARFORD COUNTY HEALTH DEPARTMENT | ||||||||
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| OtherOrganizationName: | HCHD BEHAVIORAL HEALTH YOUTH AND ADOLESCENTS 1790249365 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 S HAYS ST | ||||||||
| Address2: | |||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210143615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108771033 | ||||||||
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| Practice Location | |||||||||
| Address1: | 253 PARADISE RD | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210012324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102735681 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2019 | ||||||||
| LastUpdateDate: | 01/21/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | AUSTIN | ||||||||
| AuthorizedOfficialFirstName: | MARCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DEPUTY HEALTH OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4108771033 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HARFORD COUNTY HEALTH DEPARTMENT | ||||||||
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| NPICertificationDate: | 01/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.