| Kennedy Krieger Associates, Inc - Mental Health Group Provider | |
|
707 N. Broadway Baltimore MD 21205 | |
| (443) 923-9200 | |
| (443) 923-9405 |
| Full Name | Kennedy Krieger Associates, Inc - Mental Health Group Provider |
|---|---|
| Speciality | Pediatrics |
| Location | 707 N. Broadway, Baltimore, Maryland |
| Authorized Official Name and Position | Mike J Neuman (VICE PRESIDENT FINANCE) |
| Authorized Official Contact | 4439231810 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kennedy Krieger Associates, Inc - Mental Health Group Provider P.o. Box 744865 Atlanta GA 30374 Ph: (443) 923-1872 | Kennedy Krieger Associates, Inc - Mental Health Group Provider 707 N. Broadway Baltimore MD 21205 Ph: (443) 923-9200 |
| NPI Number | 1215327259 |
|---|---|
| Provider Enumeration Date | 01/29/2015 |
| Last Update Date | 09/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215327259 | NPI | - | NPPES |
| 168641100 | Medicaid | MD | |
| F158 | Other | MD | BLUE CROSS FEDERAL |
| K631 | Other | MD | BLUE CROSS MARYLAND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
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