Provider Demographics
NPI:1548226749
Name:JONAS, ALICE S (APRN/PMH)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:S
Last Name:JONAS
Suffix:
Gender:F
Credentials:APRN/PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2726
Mailing Address - Country:US
Mailing Address - Phone:443-540-1526
Mailing Address - Fax:410-882-1079
Practice Address - Street 1:2 OAKWAY ROAD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:443-540-1526
Practice Address - Fax:410-882-1079
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR063886364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD754219400Medicaid
MD215361OtherJOHNS HOPKINS HEALTHCARE
MDCR53-0001OtherCAREFIRST BLUECROSS BLUESHIELD