Provider Demographics
NPI:1902142839
Name:BEHAVIORAL HEALTHCARE OF MARYLAND
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTHCARE OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILBUR
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:CORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-891-2077
Mailing Address - Street 1:1405 MADISON PARK DRIVE SUITE 1B
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-487-6302
Mailing Address - Fax:443-517-6072
Practice Address - Street 1:1405 MADISON PARK DRIVE SUITE 1B
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-487-6302
Practice Address - Fax:443-517-6072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH-531261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)