Healthcare Provider Details

I. General information

NPI: 1144334178
Provider Name (Legal Business Name): MARYLAND TREATMENT CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3243 EASTERN AVE
BALTIMORE MD
21224-4013
US

IV. Provider business mailing address

3243 EASTERN AVE
BALTIMORE MD
21224-4013
US

V. Phone/Fax

Practice location:
  • Phone: 410-276-0153
  • Fax: 410-732-0362
Mailing address:
  • Phone: 410-276-0153
  • Fax: 410-732-0362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number StateMD
# 6
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number903870
License Number StateMD

VIII. Authorized Official

Name: MR. WILLIAM J ROBY
Title or Position: EXECUTIVE VICE PRESIDENT
Credential: MBA
Phone: 301-447-2361