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General NPI Number Information
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NPI Number | 1417424466
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Entity Type | Organization
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Legal Business Name | HEALTHPORT
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 828 AIRPAX RD # 600B
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City | CAMBRIDGE
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State | MD
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Zip | 21613-6401
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Country | US
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Telephone | 443-493-2429
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Fax |
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Provider Business Mailing Address
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Address Line | 208 E MAIN ST STE C
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City | SALISBURY
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State | MD
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Zip | 21801-4923
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Country | US
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Telephone | 410-341-3420
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Fax | 410-341-3397
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | KRISTINE GARTLITZ
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Credential | LCSW-C
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Telephone | 410-341-3420
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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 |
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License Number State |
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