Provider Demographics
NPI:1366724767
Name:STEP BY STEP OF MARYLAND
Entity type:Organization
Organization Name:STEP BY STEP OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHAJUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-744-5200
Mailing Address - Street 1:3602 MOHAWK AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207
Mailing Address - Country:US
Mailing Address - Phone:410-744-5200
Mailing Address - Fax:443-341-6609
Practice Address - Street 1:3602 MOHAWK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-7665
Practice Address - Country:US
Practice Address - Phone:410-744-5200
Practice Address - Fax:443-341-6609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0002369683Medicaid