Provider Demographics
NPI:1114081452
Name:BEHAVIORAL HEALTH PARTNERS OF FREDERICK, INC.
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH PARTNERS OF FREDERICK, INC.
Other - Org Name:BHP - PATRICK STREET
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, CORPORATE BUSINESS DEVELOPMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-938-3150
Mailing Address - Street 1:6501 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-938-3000
Mailing Address - Fax:410-938-3159
Practice Address - Street 1:219 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6933
Practice Address - Country:US
Practice Address - Phone:301-662-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL HEALTH PARTNERS OF FREDERICK, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2132261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211702901Medicaid
MD214000Medicare PIN