Healthcare Provider Details

I. General information

NPI: 1508781121
Provider Name (Legal Business Name): MY SOCIAL SPACE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 N DURHAM ST
BALTIMORE MD
21205-1468
US

IV. Provider business mailing address

1012 N DURHAM ST
BALTIMORE MD
21205-1468
US

V. Phone/Fax

Practice location:
  • Phone: 410-504-7784
  • Fax:
Mailing address:
  • Phone: 410-504-7784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DEANDRE PIERRE JOHNSON
Title or Position: CEO
Credential:
Phone: 410-504-7784