Provider Demographics
NPI:1326376302
Name:MAPLE SHADE YOUTH AND FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:MAPLE SHADE YOUTH AND FAMILY SERVICES, INC.
Other - Org Name:PRINCESS ANNE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HOLLOWAY-HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-621-5177
Mailing Address - Street 1:11760 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-1239
Mailing Address - Country:US
Mailing Address - Phone:410-621-5177
Mailing Address - Fax:410-621-5051
Practice Address - Street 1:11760 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-1239
Practice Address - Country:US
Practice Address - Phone:410-621-5177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health