MEDICARE: TEEN CONNECTION

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	261QH0100X	Health Service Clinic/Center	R133142	MD

General Provider Information

NPI Number	:	1912194390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEEN CONNECTION

Provider Business Mailing Address
First Line	:	1400 SPRING ST
Second Line	:	SUITE 200
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2735
Country	:	US
Telephone Number	:	301-565-0914
Fax Number	:	301-565-0916

Provider Business Practice Location Address
First Line	:	1400 SPRING ST
Second Line	:	SUITE 200
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2735
Country	:	US
Telephone Number	:	301-565-0914
Fax Number	:	301-565-0916

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. KAREN BUTLER COLBERT
Credential	:	NURSE PRACTITIONER
Telephone Number	:	301-565-0914

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	09/28/2007

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Directions to “TEEN CONNECTION ” Practice Location

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