MEDICARE: DBT OF MARYLAND

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1225642101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DBT OF MARYLAND

Provider Business Mailing Address
First Line	:	10630 LITTLE PATUXENT PKWY STE 209B
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3264
Country	:	US
Telephone Number	:	410-740-8066
Fax Number	:	410-740-8068

Provider Business Practice Location Address
First Line	:	7600 YORK RD
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-7500
Country	:	US
Telephone Number	:	410-740-8066
Fax Number	:	410-740-8068

Authorized Official
Title or Position	:	CFO
Name	:	AMY ROTTIER
Credential	:
Telephone Number	:	410-740-8066

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	09/08/2020

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Directions to “DBT OF MARYLAND ” Practice Location

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