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General NPI Number Information
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NPI Number | 1437118742
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Entity Type | Organization
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Legal Business Name | CHESAPEAKE BEHAVIORAL HEALTH CENTER, LLC
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 217 MAIN ST SUITE B
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City | REISTERSTOWN
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State | MD
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Zip | 21136-1213
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Country | US
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Telephone | 410-833-0581
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Fax | 410-833-8604
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Provider Business Mailing Address
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Address Line | 217 MAIN ST SUITE B
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City | REISTERSTOWN
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State | MD
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Zip | 21136-1213
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Country | US
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Telephone | 410-833-0581
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Fax | 410-833-8604
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. LUCY J. CORREA-CASHDOLLAR
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Credential | R.N.
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Telephone | 410-833-0581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0020136
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License Number State | MD
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