Healthcare Provider Details

I. General information

NPI: 1639908965
Provider Name (Legal Business Name): QUEENS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E CHASE ST STE 1125
BALTIMORE MD
21202-2565
US

IV. Provider business mailing address

1 E CHASE ST STE 1125
BALTIMORE MD
21202-2565
US

V. Phone/Fax

Practice location:
  • Phone: 410-365-8004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MILDRED QUEENS
Title or Position: CEO/OWNER
Credential:
Phone: 443-703-8838