Provider Demographics
NPI:1437118742
Name:CHESAPEAKE BEHAVIORAL HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:CHESAPEAKE BEHAVIORAL HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORREA-CASHDOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-833-0581
Mailing Address - Street 1:217 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1213
Mailing Address - Country:US
Mailing Address - Phone:410-833-0581
Mailing Address - Fax:410-833-8604
Practice Address - Street 1:217 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1213
Practice Address - Country:US
Practice Address - Phone:410-833-0581
Practice Address - Fax:410-833-8604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00201362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD225POtherMEDICARE GROUP NUMBER
MD0007543711OtherAETNA
MDK876OtherGHMSI & BLUE CHOICE, INC
MD4168160 00Medicaid
MD284CCHOtherCAREFIRST OF MARYLAND