MEDICARE: ST JEROME COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101200000X	Drama Therapist
2	101Y00000X	Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	101YP1600X	Pastoral Counselor
5	101YP2500X	Professional Counselor
6	101YS0200X	School Counselor
7	103TC0700X	Clinical Psychologist
8	103TC1900X	Counseling Psychologist
9	103TC2200X	Clinical Child & Adolescent Psychologist
10	103TS0200X	School Psychologist
11	104100000X	Social Worker
12	1041C0700X	Clinical Social Worker
13	1041S0200X	School Social Worker
14	106H00000X	Marriage & Family Therapist
15	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1205766813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JEROME COUNSELING

Provider Business Mailing Address
First Line	:	11001 HIDDEN FOX CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-6124
Country	:	US
Telephone Number	:	860-501-0282
Fax Number	:

Provider Business Practice Location Address
First Line	:	5205 43RD AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-2001
Country	:	US
Telephone Number	:	860-501-0282
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. JEREMY LEE
Credential	:
Telephone Number	:	860-501-0282

Provider Enumeration Date	:	05/23/2026
Last Update Date	:	05/23/2026

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Directions to “ST JEROME COUNSELING ” Practice Location

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