Healthcare Provider Details

I. General information

NPI: 1366930646
Provider Name (Legal Business Name): ST.JEROME CATHOLIC CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 43RD AVE
HYATTSVILLE MD
20781-2001
US

IV. Provider business mailing address

5205 43RD AVE
HYATTSVILLE MD
20781-2001
US

V. Phone/Fax

Practice location:
  • Phone: 301-927-6684
  • Fax: 301-927-9167
Mailing address:
  • Phone: 301-927-6684
  • Fax: 301-927-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS REBECCA MARIE MULLAN
Title or Position: MARRIAGE & FAMILY COUNSELOR
Credential: LCPC
Phone: 301-927-6684