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General NPI Number Information
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NPI Number | 1548511686
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Entity Type | Organization
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Legal Business Name | BAYSIDE BEHAVIORAL HEALTH OF ANNAPOLIS
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 134 HOLIDAY CT SUITE 302
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7008
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Country | US
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Telephone | 410-266-1600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 225
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City | PASADENA
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State | MD
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Zip | 21123-0225
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MELANIE OGUNMEFUN
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Credential |
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Telephone | 410-266-1600
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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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