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General NPI Number Information
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NPI Number | 1679206080
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Entity Type | Organization
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Legal Business Name | BLUEFISH BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 07/04/2022
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 3261 OLD WASHINGTON RD STE 2020
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City | WALDORF
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State | MD
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Zip | 20602-3231
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Country | US
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Telephone | 240-780-8254
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 575
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City | PORT TOBACCO
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State | MD
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Zip | 20677-0575
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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 | OWNER
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Name | DR. JESSICA PECK
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Credential | PSYD
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Telephone | 240-780-8254
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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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