Provider Demographics
NPI:1659389674
Name:DRUG TREATMENT CTR - PSYCH. ASSOC.
Entity Type:Organization
Organization Name:DRUG TREATMENT CTR - PSYCH. ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIBBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-6771
Mailing Address - Street 1:701 W PRATT ST
Mailing Address - Street 2:3RD FLR.
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1023
Mailing Address - Country:US
Mailing Address - Phone:410-328-2539
Mailing Address - Fax:410-328-8552
Practice Address - Street 1:701 W PRATT ST
Practice Address - Street 2:3RD FLR.
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1023
Practice Address - Country:US
Practice Address - Phone:410-328-2539
Practice Address - Fax:410-328-8552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401610600Medicaid