MEDICARE: BEHAVIORLINK, 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	103K00000X	Behavior Analyst	1-11-8379	MD

General Provider Information

NPI Number	:	1255690194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORLINK, LLC

Provider Business Mailing Address
First Line	:	4157 MOUNTAIN RD # 264
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-4455
Country	:	US
Telephone Number	:	443-414-1843
Fax Number	:

Provider Business Practice Location Address
First Line	:	4157 MOUNTAIN RD # 264
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-4455
Country	:	US
Telephone Number	:	443-414-1843
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. WHITNEY MCCARTHY
Credential	:	M.S., BCBA
Telephone Number	:	443-414-1843

Provider Enumeration Date	:	05/13/2012
Last Update Date	:	05/13/2012

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