Provider Demographics
NPI:1194334268
Name:MENTAL HEALTH BALTIMORE, LLC
Entity type:Organization
Organization Name:MENTAL HEALTH BALTIMORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMH
Authorized Official - Phone:443-396-2419
Mailing Address - Street 1:1 N CHARLES ST STE 2425
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3765
Mailing Address - Country:US
Mailing Address - Phone:443-396-2419
Mailing Address - Fax:443-347-2464
Practice Address - Street 1:1 N CHARLES ST STE 2425
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3765
Practice Address - Country:US
Practice Address - Phone:443-396-2419
Practice Address - Fax:443-347-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD614084000Medicaid