Healthcare Provider Details

I. General information

NPI: 1659389674
Provider Name (Legal Business Name): DRUG TREATMENT CTR - PSYCH. ASSOC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PRATT ST 3RD FLR.
BALTIMORE MD
21201-1023
US

IV. Provider business mailing address

701 W PRATT ST 3RD FLR.
BALTIMORE MD
21201-1023
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-2539
  • Fax: 410-328-8552
Mailing address:
  • Phone: 410-328-2539
  • Fax: 410-328-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY BIBBO
Title or Position: SENIOR ADMINISTRATOR
Credential:
Phone: 410-328-6771