Provider Demographics
NPI:1760773097
Name:HARBOR AREA BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:HARBOR AREA BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUNDHATI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGINENI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:443-869-5303
Mailing Address - Street 1:1209 S ELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4914
Mailing Address - Country:US
Mailing Address - Phone:443-869-5303
Mailing Address - Fax:
Practice Address - Street 1:649 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2215
Practice Address - Country:US
Practice Address - Phone:443-869-5303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16270261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health