Provider Demographics
NPI:1225560121
Name:EASTER SEALS DC MD VA
Entity Type:Organization
Organization Name:EASTER SEALS DC MD VA
Other - Org Name:EASTER SEALS GREATER WASHINGTON BALTIMORE REGION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:REG. DIR. OF EARLY INTERVENTION
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIMKA
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:202-387-4434
Mailing Address - Street 1:1420 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2701
Mailing Address - Country:US
Mailing Address - Phone:202-387-4434
Mailing Address - Fax:
Practice Address - Street 1:1420 SPRING ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2701
Practice Address - Country:US
Practice Address - Phone:202-387-4434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA071103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty