Provider Demographics
NPI:1609880079
Name:NEW VISION BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:NEW VISION BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:MSHA
Authorized Official - Phone:410-254-4343
Mailing Address - Street 1:5718 HARFORD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2237
Mailing Address - Country:US
Mailing Address - Phone:410-254-4343
Mailing Address - Fax:410-254-4342
Practice Address - Street 1:5718 HARFORD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2237
Practice Address - Country:US
Practice Address - Phone:410-254-4343
Practice Address - Fax:410-254-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406728200Medicaid