MEDICARE: WAY OF HOPE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	2084P0800X	Psychiatry Physician
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1588221238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAY OF HOPE INC.

Provider Business Mailing Address
First Line	:	7412 RICKSWAY RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21208-5719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3312 W NORTH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-3018
Country	:	US
Telephone Number	:	443-794-9094
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIE G. FERNELIS
Credential	:
Telephone Number	:	443-794-9094

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	05/28/2019

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Directions to “WAY OF HOPE INC. ” Practice Location

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