Healthcare Provider Details

I. General information

NPI: 1043709637
Provider Name (Legal Business Name): BK BEHAVIORAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 CHERRY LANE CT STE 202-203
LAUREL MD
20707
US

IV. Provider business mailing address

14300 CHERRY LANE CT STE 202-203
LAUREL MD
20707-4958
US

V. Phone/Fax

Practice location:
  • Phone: 240-360-2637
  • Fax: 240-360-2647
Mailing address:
  • Phone: 240-360-2637
  • Fax: 240-360-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: BERNADETTE S KAMARA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 301-346-4687