Healthcare Provider Details

I. General information

NPI: 1932803962
Provider Name (Legal Business Name): EMPOWERED BEHAVIOR SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 SOUTH BOULDIN STREET
BALTIMORE MD
21224
US

IV. Provider business mailing address

3717 BOSTON ST STE 393
BALTIMORE MD
21224-5752
US

V. Phone/Fax

Practice location:
  • Phone: 443-203-9383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: RIANE FITZGERALD
Title or Position: CEO
Credential:
Phone: 443-203-9383