Basic Information
| Provider Information | |||||||||
| NPI: | 1962717553 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CONTEMPORARY FAMILY SERVICES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 6525 BELCREST RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | HYATTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207822063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017798345 | ||||||||
| FaxNumber: | 3017798417 | ||||||||
| Practice Location | |||||||||
| Address1: | 6525 BELCREST RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | HYATTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207822063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017798345 | ||||||||
| FaxNumber: | 3017798417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2010 | ||||||||
| LastUpdateDate: | 06/10/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PIERCE | ||||||||
| AuthorizedOfficialFirstName: | COREY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 3017798345 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | MD | N | Agencies | Case Management | 251S00000X | N | Agencies | Community/Behavioral Health | 252Y00000X | N | Agencies | Early Intervention Provider Agency | 251E00000X | N | Agencies | Home Health | 253J00000X | MD | Y | Agencies | Foster Care Agency |
No ID Information.