Provider Demographics
NPI:1366930646
Name:ST.JEROME CATHOLIC CHURCH
Entity type:Organization
Organization Name:ST.JEROME CATHOLIC CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MULLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-927-6684
Mailing Address - Street 1:5205 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-2001
Mailing Address - Country:US
Mailing Address - Phone:301-927-6684
Mailing Address - Fax:301-927-9167
Practice Address - Street 1:5205 43RD AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-2001
Practice Address - Country:US
Practice Address - Phone:301-927-6684
Practice Address - Fax:301-927-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health