MEDICARE: DEPARTMENT OF JUVENILE 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1861612897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPARTMENT OF JUVENILE SERVICES

Provider Business Mailing Address
First Line	:	124 CAMP 4 RD
Second Line	:
City	:	SWANTON
State	:	MD
Zip	:	21561-1329
Country	:	US
Telephone Number	:	301-359-9190
Fax Number	:	301-359-0811

Provider Business Practice Location Address
First Line	:	124 CAMP 4 RD
Second Line	:
City	:	SWANTON
State	:	MD
Zip	:	21561-1329
Country	:	US
Telephone Number	:	301-359-9190
Fax Number	:	301-359-0811

Authorized Official
Title or Position	:	ADMINISTRATOR-CLINICAL SUPERVISOR
Name	:	MS. TAMMY LYNN FISHER
Credential	:
Telephone Number	:	301-359-9190

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	08/22/2020

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Directions to “DEPARTMENT OF JUVENILE SERVICES ” Practice Location

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