Provider Demographics
NPI:1629432018
Name:COMMUNITY BRIDGE BUILDERS OF MARYLAND LLC
Entity Type:Organization
Organization Name:COMMUNITY BRIDGE BUILDERS OF MARYLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:MAITH
Authorized Official - Suffix:SR
Authorized Official - Credentials:MSW
Authorized Official - Phone:410-926-8655
Mailing Address - Street 1:5900 YORK RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3041
Mailing Address - Country:US
Mailing Address - Phone:443-885-9173
Mailing Address - Fax:
Practice Address - Street 1:5900 YORK RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3041
Practice Address - Country:US
Practice Address - Phone:443-885-9173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22634101YM0800X
251B00000X, 251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty