MEDICARE: MARYLAND HEALTH FOUNDATION LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	106H00000X	Marriage & Family Therapist
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1851115216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYLAND HEALTH FOUNDATION LLC

Provider Business Mailing Address
First Line	:	6910 HOLABIRD AVE
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222-1788
Country	:	US
Telephone Number	:	443-761-9169
Fax Number	:

Provider Business Practice Location Address
First Line	:	6910 HOLABIRD AVE
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222-1788
Country	:	US
Telephone Number	:	443-761-9169
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MUSTAFA ABDULRAHMAN
Credential	:
Telephone Number	:	443-761-9169

Provider Enumeration Date	:	11/12/2024
Last Update Date	:	11/12/2024

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Directions to “MARYLAND HEALTH FOUNDATION LLC ” Practice Location

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