Provider Demographics
NPI:1114239555
Name:CSU HELENE FULD SON SBHC/COMM CTR @ ST FRAN ACAD
Entity type:Organization
Organization Name:CSU HELENE FULD SON SBHC/COMM CTR @ ST FRAN ACAD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COPES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-951-6100
Mailing Address - Street 1:501 E CHASE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4206
Mailing Address - Country:US
Mailing Address - Phone:410-528-8747
Mailing Address - Fax:410-528-8748
Practice Address - Street 1:501 E CHASE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4206
Practice Address - Country:US
Practice Address - Phone:410-528-8747
Practice Address - Fax:410-528-8748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21D1004200261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health