MEDICARE: MS. JAIME GAUDET M.S.

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	101YP2500X	Professional Counselor	PC004461	PA
2	101YM0800X	Mental Health Counselor	LC12776	MD

General Provider Information

NPI Number	:	1629288220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAIME GAUDET M.S.

Provider Business Mailing Address
First Line	:	10813 PITCH CIR
Second Line	:
City	:	MONROVIA
State	:	MD
Zip	:	21770-6057
Country	:	US
Telephone Number	:	609-792-5690
Fax Number	:

Provider Business Practice Location Address
First Line	:	5820 YORK RD STE 201
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21212-3620
Country	:	US
Telephone Number	:	410-800-2169
Fax Number	:	410-777-8742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	02/15/2024

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