| Awaken The Spirit Wellness Center | |
|
9 Newburg Ave Ste 100 Catonsville MD 21228-5168 | |
| (410) 747-9743 | |
| (410) 747-9910 |
| Full Name | Awaken The Spirit Wellness Center |
|---|---|
| Speciality | Social Worker |
| Location | 9 Newburg Ave Ste 100, Catonsville, Maryland |
| Authorized Official Name and Position | Cheryl A Depetro (OWNER) |
| Authorized Official Contact | 4107479743 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Awaken The Spirit Wellness Center 73 Edmondson Ridge Rd # 1 Catonsville MD 21228-1966 Ph: (410) 747-9743 | Awaken The Spirit Wellness Center 9 Newburg Ave Ste 100 Catonsville MD 21228-5168 Ph: (410) 747-9743 |
| NPI Number | 1124492665 |
|---|---|
| Provider Enumeration Date | 11/20/2015 |
| Last Update Date | 09/26/2021 |
| Certification Date | 09/26/2021 |
| Medicare PECOS PAC ID | 1951606318 |
|---|---|
| Medicare Enrollment ID | O20160223000473 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124492665 | NPI | - | NPPES |
| 929R | Other | MD | MEDICARE |
| 149702200 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 09177 (Maryland) | Primary |
| 171100000X | Acupuncturist | U01507 (Maryland) | Secondary |
| Provider Name | Cheryl A Depetro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023191418 PECOS PAC ID: 3072763853 Enrollment ID: I20121102000066 |
| Provider Name | Amber L Schmidt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932572963 PECOS PAC ID: 5597046102 Enrollment ID: I20161219002273 |
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