Healthcare Provider Details

I. General information

NPI: 1740177294
Provider Name (Legal Business Name): B'MORE MENTAL HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 40TH ST STE 206
BALTIMORE MD
21211-2108
US

IV. Provider business mailing address

711 W 40TH ST STE 206
BALTIMORE MD
21211-2108
US

V. Phone/Fax

Practice location:
  • Phone: 410-842-6055
  • Fax:
Mailing address:
  • Phone: 410-842-6055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE CORNELL
Title or Position: OWNER
Credential:
Phone: 410-842-6055