MEDICARE: SUPPORT PLUS, LLC

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	09861	MD

General Provider Information

NPI Number	:	1942457445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORT PLUS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 32700
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21282-2700
Country	:	US
Telephone Number	:	410-494-4495
Fax Number	:	410-494-4496

Provider Business Practice Location Address
First Line	:	1301 YORK RD
Second Line	:	SUITE 400
City	:	LUTHERVILLE TIMONIUM
State	:	MD
Zip	:	21093-6035
Country	:	US
Telephone Number	:	410-494-4495
Fax Number	:	410-494-4496

Authorized Official
Title or Position	:	SOCIAL WORKER- GEN. MANAGER
Name	:	BARBARA L BRODIE
Credential	:	LCSW-C
Telephone Number	:	410-494-4495

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	08/26/2008

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