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General NPI Number Information
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NPI Number | 1144019936
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Entity Type | Organization
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Legal Business Name | GRATITUDE BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 417 ACADEMY ST
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City | CAMBRIDGE
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State | MD
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Zip | 21613-1958
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Country | US
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Telephone | 410-924-5520
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Fax | 410-770-4440
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Provider Business Mailing Address
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Address Line | 600 DOVER RD STE 107
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City | EASTON
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State | MD
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Zip | 21601-3846
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Country | US
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Telephone | 410-770-4446
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Fax | 410-770-4440
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Authorized Official
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Title or Position | DIRECTOR / CEO
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Name | MICHAEL L RISSOLO
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Credential |
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Telephone | 410-924-4513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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