Basic Information
| Provider Information | |||||||||
| NPI: | 1992302442 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED BEHAVIORAL HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1003 W 7TH ST | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217014106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013451022 | ||||||||
| FaxNumber: | 3015605558 | ||||||||
| Practice Location | |||||||||
| Address1: | 532 BALTIMORE BLVD STE 403 | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211576146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013451022 | ||||||||
| FaxNumber: | 3015605558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2020 | ||||||||
| LastUpdateDate: | 10/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | KURDIAN | ||||||||
| AuthorizedOfficialFirstName: | VERA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3013451022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.