| Lutheran Mission Society Of Maryland | |
|
601 Hammonds Ln Baltimore MD 21225-3330 | |
| (410) 636-0123 | |
| (410) 636-6984 |
| Full Name | Lutheran Mission Society Of Maryland |
|---|---|
| Speciality | Social Worker |
| Location | 601 Hammonds Ln, Baltimore, Maryland |
| Authorized Official Name and Position | Justin Griepentrog (PROGRAM DIRECTOR) |
| Authorized Official Contact | 4106360123 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lutheran Mission Society Of Maryland 601 Hammonds Ln Baltimore MD 21225-3330 Ph: (410) 636-0123 | Lutheran Mission Society Of Maryland 601 Hammonds Ln Baltimore MD 21225-3330 Ph: (410) 636-0123 |
| NPI Number | 1861749319 |
|---|---|
| Provider Enumeration Date | 08/14/2012 |
| Last Update Date | 01/20/2015 |
| Medicare PECOS PAC ID | 7719201896 |
|---|---|
| Medicare Enrollment ID | O20150120001633 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861749319 | NPI | - | NPPES |
| 815091 | Other | MD | VALUE OPTIONS |
| 600782589 | Other | MD | MAGELLAN |
| AV09 | Other | MD | BCBS CAREFIRST OF MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kelly M Hoenshell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083157200 PECOS PAC ID: 8820357585 Enrollment ID: I20180125002703 |
| Provider Name | Eldon Charles Watts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134766777 PECOS PAC ID: 9537582309 Enrollment ID: I20200713001339 |
| Provider Name | Tracy L Meyer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225704232 PECOS PAC ID: 5799212965 Enrollment ID: I20241230001969 |
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