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General NPI Number Information
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NPI Number | 1275774556
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Entity Type | Organization
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Legal Business Name | BOWIE THERAPEUTIC NURSERY CENTER, INC.
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 03/16/2009
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Provider Practice Location Address
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Address Line | 3120 BELAIR DR
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City | BOWIE
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State | MD
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Zip | 20715-3101
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Country | US
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Telephone | 301-262-9167
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Fax | 301-805-5094
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Provider Business Mailing Address
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Address Line | 3120 BELAIR DR
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City | BOWIE
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State | MD
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Zip | 20715-3101
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Country | US
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Telephone | 301-262-9167
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Fax | 301-805-5094
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. KATHLEEN A KAUFFMANN
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Credential | LCSW-C
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Telephone | 301-262-9167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 21381
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License Number State | MD
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