Basic Information
| Provider Information | |||||||||
| NPI: | 1821450768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIELE | ||||||||
| FirstName: | JEFF | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 426 DORCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216132446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439448070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 BYRN ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216131908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102285511 | ||||||||
| FaxNumber: | 4109012764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2016 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LC8069 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.