Healthcare Provider Details

I. General information

NPI: 1548185978
Provider Name (Legal Business Name): ITINERIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 ROCKROSE AVE
BALTIMORE MD
21211-1329
US

IV. Provider business mailing address

2050 ROCKROSE AVE
BALTIMORE MD
21211-1329
US

V. Phone/Fax

Practice location:
  • Phone: 443-275-1100
  • Fax:
Mailing address:
  • Phone: 443-275-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BLUM
Title or Position: DIRECTOR OF PEOPLE AND CULTURE
Credential:
Phone: 443-275-1100