Healthcare Provider Details

I. General information

NPI: 1598669236
Provider Name (Legal Business Name): JAIMIE NICOLE DIFILIPPO ADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 W LOMBARD ST
BALTIMORE MD
21223-3133
US

IV. Provider business mailing address

103 THREE COIN WAY
GLEN BURNIE MD
21060-0857
US

V. Phone/Fax

Practice location:
  • Phone: 866-578-7471
  • Fax:
Mailing address:
  • Phone: 410-863-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADT4147
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: