MEDICARE: CAROLINE COUNTY HEALTH DEPARTMENT, DHMH, MD

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	251K00000X	Public Health or Welfare Agency	9812	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9812	OTHER	MD	OUTPATIENT ADDICTION

General Provider Information

NPI Number	:	1104802578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINE COUNTY HEALTH DEPARTMENT, DHMH, MD

Provider Business Mailing Address
First Line	:	104 FRANKLIN ST
Second Line	:	P.O.BOX 10
City	:	DENTON
State	:	MD
Zip	:	21629-1208
Country	:	US
Telephone Number	:	410-479-1882
Fax Number	:	410-479-4918

Provider Business Practice Location Address
First Line	:	104 FRANKLIN ST
Second Line	:
City	:	DENTON
State	:	MD
Zip	:	21629-1208
Country	:	US
Telephone Number	:	410-479-1882
Fax Number	:	410-479-4918

Authorized Official
Title or Position	:	PSYCHOLOGIST/PROGRAM ADMINISTRATOR
Name	:	DR. BETTY MUMFORD MALKUS
Credential	:	PH.D.
Telephone Number	:	410-479-1882

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	08/22/2020

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Directions to “CAROLINE COUNTY HEALTH DEPARTMENT, DHMH, MD ” Practice Location

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