MEDICARE: A BEAUTIFUL MIND LLC

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	:	1902542624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BEAUTIFUL MIND LLC

Provider Business Mailing Address
First Line	:	1802 EUTAW PL
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-3805
Country	:	US
Telephone Number	:	443-801-3134
Fax Number	:

Provider Business Practice Location Address
First Line	:	1319 WOODBRIDGE STATION WAY STE 101
Second Line	:
City	:	EDGEWOOD
State	:	MD
Zip	:	21040-3852
Country	:	US
Telephone Number	:	443-961-7560
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	CAMILLE G. MATTHEWS
Credential	:
Telephone Number	:	410-728-3737

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	05/05/2022

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