Provider Demographics
NPI:1346410495
Name:THE CHILDRENS HOME
Entity Type:Organization
Organization Name:THE CHILDRENS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW C
Authorized Official - Phone:410-744-7310
Mailing Address - Street 1:205 BLOOMSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-0000
Mailing Address - Country:US
Mailing Address - Phone:410-744-7310
Mailing Address - Fax:410-455-0071
Practice Address - Street 1:205 BLOOMSBURY AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-0000
Practice Address - Country:US
Practice Address - Phone:410-744-7310
Practice Address - Fax:410-455-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9305251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health