MEDICARE: NEW VISION BEHAVIORAL HEALTH SERVICES INC

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	251S00000X	Community/Behavioral Health Agency	5791	MD

General Provider Information

NPI Number	:	1487911889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VISION BEHAVIORAL HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	5718 HARFORD RD
Second Line	:	SUITE 103
City	:	BALTIMORE
State	:	MD
Zip	:	21214-2237
Country	:	US
Telephone Number	:	410-254-4343
Fax Number	:	410-254-4342

Provider Business Practice Location Address
First Line	:	4710 PENNINGTON AVE
Second Line	:	2ND FLOOR, SUITE 3
City	:	BALTIMORE
State	:	MD
Zip	:	21226-1405
Country	:	US
Telephone Number	:	410-254-4343
Fax Number	:	410-254-4342

Authorized Official
Title or Position	:	CEO
Name	:	CARMEN CASTANG
Credential	:	MHSA
Telephone Number	:	443-326-2344

Provider Enumeration Date	:	04/23/2012
Last Update Date	:	04/23/2012

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