Provider Demographics
NPI:1639586530
Name:CHESAPEAKE CENTER FOR YOUTH DEVELOPMENT
Entity Type:Organization
Organization Name:CHESAPEAKE CENTER FOR YOUTH DEVELOPMENT
Other - Org Name:THE PEAK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY DIRECTOR OR PROGRAM SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-766-9452
Mailing Address - Street 1:7477 BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3504
Mailing Address - Country:US
Mailing Address - Phone:410-766-9452
Mailing Address - Fax:
Practice Address - Street 1:7477 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3504
Practice Address - Country:US
Practice Address - Phone:410-766-9452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-13
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD096461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty