Healthcare Provider Details

I. General information

NPI: 1811823081
Provider Name (Legal Business Name): JALYN POMETTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9505 REISTERSTOWN RD
OWINGS MILLS MD
21117-4451
US

IV. Provider business mailing address

111 DUMBARTON RD
BALTIMORE MD
21212-1417
US

V. Phone/Fax

Practice location:
  • Phone: 888-541-1868
  • Fax:
Mailing address:
  • Phone: 301-325-2096
  • Fax: 301-325-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: