| Sheppard Pratt Health System, Inc. | |
|
407 Central Ave Reisterstown MD 21136-1854 | |
| (410) 517-5400 | |
| (410) 517-5600 |
| Full Name | Sheppard Pratt Health System, Inc. |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 407 Central Ave, Reisterstown, Maryland |
| Authorized Official Name and Position | Bonnie B Katz (VP CORPORATE BUSINESS DEVELOPMENT) |
| Authorized Official Contact | 4109383150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sheppard Pratt Health System, Inc. 6501 N Charles St Baltimore MD 21204-6819 Ph: (410) 938-3150 | Sheppard Pratt Health System, Inc. 407 Central Ave Reisterstown MD 21136-1854 Ph: (410) 517-5400 |
| NPI Number | 1811041163 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 08/10/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811041163 | NPI | - | NPPES |
| 681500600 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 03-64551 (Maryland) | Primary |
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