Provider Demographics
NPI:1114345352
Name:COROZON CENTER
Entity Type:Organization
Organization Name:COROZON CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MISS
Authorized Official - First Name:WILHELMENA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:VANDENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-790-4833
Mailing Address - Street 1:1344 W 41ST ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1549
Mailing Address - Country:US
Mailing Address - Phone:410-790-4833
Mailing Address - Fax:
Practice Address - Street 1:1344 W 41ST ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1549
Practice Address - Country:US
Practice Address - Phone:410-790-4833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty