MEDICARE: PROSPER HEALTH AND BEHAVIORAL CARE SERVICES

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1588400030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSPER HEALTH AND BEHAVIORAL CARE SERVICES

Provider Business Mailing Address
First Line	:	13 DEVLON CT
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-6124
Country	:	US
Telephone Number	:	443-869-6490
Fax Number	:

Provider Business Practice Location Address
First Line	:	2925 LORD BALTIMORE DR STE 301
Second Line	:
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244-2653
Country	:	US
Telephone Number	:	443-869-6490
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JULIANA ADA NWAKAMMA
Credential	:
Telephone Number	:	443-799-4247

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	06/23/2026

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