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General NPI Number Information
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NPI Number | 1073002762
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Entity Type | Organization
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Legal Business Name | BK BEHAVIORAL HEALTH CENTER
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 1805 PENNSYLVANIA AVE., SUITE 102
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City | BALTIMORE
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State | MD
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Zip | 21217-4958
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Country | US
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Telephone | 240-360-2637
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Fax | 240-360-2647
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Provider Business Mailing Address
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Address Line | 1805 PENNSYLVANIA AVE., SUITE 102
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City | BALTIMORE
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State | MD
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Zip | 21217-4958
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Country | US
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Telephone | 240-360-2637
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Fax | 240-360-2647
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | BERNADETTE S KAMARA
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Credential |
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Telephone | 301-346-4687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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