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General NPI Number Information
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NPI Number | 1376803346
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Entity Type | Organization
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Legal Business Name | DUNDALK YOUTH SERVICE CENTER
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 05/23/2012
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Provider Practice Location Address
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Address Line | 2660 YORKWAY
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City | BALTIMORE
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State | MD
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Zip | 21222-4432
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Country | US
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Telephone | 410-288-4356
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Fax |
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Provider Business Mailing Address
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Address Line | 2660 YORKWAY
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City | BALTIMORE
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State | MD
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Zip | 21222-4432
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Country | US
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Telephone | 410-288-4356
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Fax |
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | JENNIFER MCCANN
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Credential |
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Telephone | 410-288-4356
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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 | 13660
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License Number State | MD
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