Provider Demographics
NPI:1134279698
Name:THE MARYLAND SCHOOL FOR THE BLIND
Entity Type:Organization
Organization Name:THE MARYLAND SCHOOL FOR THE BLIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KMIECIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-319-5720
Mailing Address - Street 1:3501 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4406
Mailing Address - Country:US
Mailing Address - Phone:410-319-5720
Mailing Address - Fax:410-319-5700
Practice Address - Street 1:3501 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4406
Practice Address - Country:US
Practice Address - Phone:410-319-5720
Practice Address - Fax:410-319-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD541368100Medicaid