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General NPI Number Information
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NPI Number | 1306130117
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF MARYLAND MEDICAL CENTER
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 06/09/2011
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Provider Practice Location Address
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Address Line | 611 S CHARLES ST SUITE 4
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City | BALTIMORE
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State | MD
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Zip | 21230-3801
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Country | US
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Telephone | 410-328-2292
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Fax |
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Provider Business Mailing Address
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Address Line | 611 S CHARLES ST SUITE 4
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City | BALTIMORE
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State | MD
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Zip | 21230-3801
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Country | US
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Telephone | 410-328-2292
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER II/TEAM LEADER
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Name | MISS MANDA S BROOKS
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Credential | LCSW-C
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Telephone | 410-422-7142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16439
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License Number State | MD
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