MEDICARE: ANNE ARUNDEL COUNTY DEPT OF HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center		MD

General Provider Information

NPI Number	:	1043247364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNE ARUNDEL COUNTY DEPT OF HEALTH

Provider Business Mailing Address
First Line	:	122 LANGLEY RD N
Second Line	:	SUITES A
City	:	GLEN BURNIE
State	:	MD
Zip	:	21060-6539
Country	:	US
Telephone Number	:	410-222-6725
Fax Number	:	410-222-6748

Provider Business Practice Location Address
First Line	:	122 LANGLEY RD N
Second Line	:	SUITES A
City	:	GLEN BURNIE
State	:	MD
Zip	:	21060-6539
Country	:	US
Telephone Number	:	410-222-6725
Fax Number	:	410-222-6748

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	MS. SANDY O'NEILL
Credential	:	LCPC, NCC
Telephone Number	:	410-222-6725

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	08/22/2020

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