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General NPI Number Information
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NPI Number | 1457970048
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Entity Type | Organization
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Legal Business Name | QUALITY BHS LLC
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 9711 WASHINGTONIAN BLVD STE 550
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5789
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Country | US
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Telephone | 646-369-0681
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Fax |
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Provider Business Mailing Address
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Address Line | 2635 NOSTRAND AVE APT 1E
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City | BROOKLYN
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State | NY
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Zip | 11210-4602
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Country | US
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Telephone | 646-369-0681
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JASON ROTH
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Credential | LCSW
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Telephone | 646-369-0681
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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 |
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License Number State |
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