Provider Demographics
NPI:1861612897
Name:DEPARTMENT OF JUVENILE SERVICES
Entity type:Organization
Organization Name:DEPARTMENT OF JUVENILE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR-CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-359-9190
Mailing Address - Street 1:124 CAMP 4 RD
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:MD
Mailing Address - Zip Code:21561-1329
Mailing Address - Country:US
Mailing Address - Phone:301-359-9190
Mailing Address - Fax:301-359-0811
Practice Address - Street 1:124 CAMP 4 RD
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:MD
Practice Address - Zip Code:21561-1329
Practice Address - Country:US
Practice Address - Phone:301-359-9190
Practice Address - Fax:301-359-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health