Healthcare Provider Details

I. General information

NPI: 1003439431
Provider Name (Legal Business Name): ROBERT A. PASCAL YOUTH AND FAMILY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 12/23/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 ANNAPOLIS RD
ODENTON MD
21113-1320
US

IV. Provider business mailing address

PO BOX 180
ODENTON MD
21113-0180
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-4500
  • Fax: 410-923-1329
Mailing address:
  • Phone: 410-975-0067
  • Fax: 410-975-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIMBERLY LAMB
Title or Position: DIRECTOR OF ADMINISTRATION
Credential:
Phone: 410-975-0067