Provider Demographics
NPI:1134471188
Name:PARKER-BALTHASER, AUDREY (CAC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:PARKER-BALTHASER
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 AIRPAX RD
Mailing Address - Street 2:BLDG B STE 300
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-6401
Mailing Address - Country:US
Mailing Address - Phone:410-228-3929
Mailing Address - Fax:410-228-3810
Practice Address - Street 1:828 AIRPAX RD
Practice Address - Street 2:BLDG B STE 300
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-6401
Practice Address - Country:US
Practice Address - Phone:410-228-3929
Practice Address - Fax:410-228-3810
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0753101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)