MEDICARE: HEALTHY LIVES, LLC

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	1041C0700X	Clinical Social Worker	16481	MD

General Provider Information

NPI Number	:	1114268661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY LIVES, LLC

Provider Business Mailing Address
First Line	:	1001 PINE HEIGHTS AVE STE 303
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-5202
Country	:	US
Telephone Number	:	443-219-7901
Fax Number	:	443-835-2521

Provider Business Practice Location Address
First Line	:	1001 PINE HEIGHTS AVE STE 303
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-5202
Country	:	US
Telephone Number	:	443-219-7901
Fax Number	:	443-835-2521

Authorized Official
Title or Position	:	CEO
Name	:	MR. AHMEIN WATSON
Credential	:	LCSW-C, LCADC
Telephone Number	:	443-722-3116

Provider Enumeration Date	:	03/08/2013
Last Update Date	:	10/04/2023

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Practice Fax: 443-835-2521

Directions to “HEALTHY LIVES, LLC ” Practice Location

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