Provider Demographics
NPI:1326343096
Name:NEW VISION BEHAVIORAL HEALTHCARE,INC.
Entity Type:Organization
Organization Name:NEW VISION BEHAVIORAL HEALTHCARE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELLHAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-925-9120
Mailing Address - Street 1:4607 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2123
Mailing Address - Country:US
Mailing Address - Phone:301-925-9120
Mailing Address - Fax:301-925-4328
Practice Address - Street 1:4607 69TH AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2123
Practice Address - Country:US
Practice Address - Phone:301-925-9120
Practice Address - Fax:301-925-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD098321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty