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General NPI Number Information
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NPI Number | 1346410495
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Entity Type | Organization
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Legal Business Name | THE CHILDRENS HOME
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 205 BLOOMSBURY AVE
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City | CATONSVILLE
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State | MD
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Zip | 21228-0000
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Country | US
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Telephone | 410-744-7310
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Fax | 410-455-0071
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Provider Business Mailing Address
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Address Line | 205 BLOOMSBURY AVE
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City | CATONSVILLE
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State | MD
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Zip | 21228-0000
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Country | US
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Telephone | 410-744-7310
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Fax | 410-455-0071
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Authorized Official
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Title or Position | DEPUTY DIRECTOR
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Name | MR. MARK MITTELMAN
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Credential | LCSW C
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Telephone | 410-744-7310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 9305
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License Number State | MD
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