MEDICARE: NEW VISION BEHAVIORAL HEALTHCARE,INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	09832	MD

General Provider Information

NPI Number	:	1326343096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VISION BEHAVIORAL HEALTHCARE,INC.

Provider Business Mailing Address
First Line	:	4607 69TH AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2123
Country	:	US
Telephone Number	:	301-925-9120
Fax Number	:	301-925-4328

Provider Business Practice Location Address
First Line	:	4607 69TH AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2123
Country	:	US
Telephone Number	:	301-925-9120
Fax Number	:	301-925-4328

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	JENNIFER SHELLHAMMER
Credential	:
Telephone Number	:	301-925-9120

Provider Enumeration Date	:	01/11/2011
Last Update Date	:	01/11/2011

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