Provider Demographics
NPI:1306434188
Name:FAMILY SUPPORT CENTER OF MARYLAND, LLC
Entity type:Organization
Organization Name:FAMILY SUPPORT CENTER OF MARYLAND, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-616-3508
Mailing Address - Street 1:1921 LANSDOWNE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1707
Mailing Address - Country:US
Mailing Address - Phone:410-616-3508
Mailing Address - Fax:
Practice Address - Street 1:1921 LANSDOWNE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1707
Practice Address - Country:US
Practice Address - Phone:410-616-3508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health