Provider Demographics
NPI:1720382963
Name:PAINE- RYE, JESSICA (CAC-AD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PAINE- RYE
Suffix:
Gender:F
Credentials:CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-1824
Mailing Address - Country:US
Mailing Address - Phone:410-467-6040
Mailing Address - Fax:410-235-8807
Practice Address - Street 1:1111 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-1824
Practice Address - Country:US
Practice Address - Phone:410-467-6040
Practice Address - Fax:410-235-8807
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2023-10-24
Deactivation Date:2023-05-09
Deactivation Code:
Reactivation Date:2023-10-24
Provider Licenses
StateLicense IDTaxonomies
MDAC1742101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)