| Carol Van Doorn, Llc | |
|
209 Center St Frederick MD 21701-6309 | |
| (301) 351-7421 | |
| Not Available |
| Full Name | Carol Van Doorn, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 209 Center St, Frederick, Maryland |
| Authorized Official Name and Position | Carol Van Doorn (OWNER/THERAPIST) |
| Authorized Official Contact | 3013517421 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carol Van Doorn, Llc 1743 Castle Rock Rd Frederick MD 21701-9386 Ph: () - | Carol Van Doorn, Llc 209 Center St Frederick MD 21701-6309 Ph: (301) 351-7421 |
| NPI Number | 1003257171 |
|---|---|
| Provider Enumeration Date | 07/17/2013 |
| Last Update Date | 01/29/2015 |
| Medicare PECOS PAC ID | 0042537672 |
|---|---|
| Medicare Enrollment ID | O20150319001654 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003257171 | NPI | - | NPPES |
| 064812400 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 15354 (Maryland) | Primary |
| Provider Name | Carol Van Doorn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497096622 PECOS PAC ID: 6305163932 Enrollment ID: I20150319001756 |
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