Healthcare Provider Details

I. General information

NPI: 1104261585
Provider Name (Legal Business Name): GAUDENZIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 PARK HEIGHTS AVE
BALTIMORE MD
21215-6324
US

IV. Provider business mailing address

3643 WOODLAND AVE
BALTIMORE MD
21215-5512
US

V. Phone/Fax

Practice location:
  • Phone: 443-869-6298
  • Fax: 443-869-6433
Mailing address:
  • Phone: 443-869-6298
  • Fax: 443-849-6433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANDREA PERSON
Title or Position: DIVISION DIRECTOR
Credential: M.ED
Phone: 410-367-5501