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General NPI Number Information
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NPI Number | 1922464791
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Entity Type | Organization
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Legal Business Name | SAN MAR INC
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 8504 MAPLEVILLE RD
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City | BOONSBORO
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State | MD
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Zip | 21713-1817
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Country | US
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Telephone | 301-733-9067
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Fax |
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Provider Business Mailing Address
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Address Line | 8504 MAPLEVILLE ROAD
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City | BOONSBORO
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State | MD
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Zip | 21713
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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 | CEO
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Name | MR. BRUCE ANDERSON
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Credential |
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Telephone | 301-733-9067
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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 | 17432
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15063
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13896
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16190
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License Number State | MD
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