MEDICARE: BALTIMORE BEHAVIORAL HEALTH, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1497701783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALTIMORE BEHAVIORAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	1001 W PRATT ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21223-2662
Country	:	US
Telephone Number	:	410-962-7190
Fax Number	:	410-962-7194

Provider Business Practice Location Address
First Line	:	1001 W PRATT ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21223-2662
Country	:	US
Telephone Number	:	410-962-7190
Fax Number	:	410-962-7194

Authorized Official
Title or Position	:	CEO
Name	:	MR. WILLIAM K HATHAWAY
Credential	:
Telephone Number	:	410-962-7190

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	10/25/2007

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