Provider Demographics
NPI:1811046105
Name:BALTIMORE, MARETHA L (PLMHP, PLADC)
Entity Type:Individual
Prefix:
First Name:MARETHA
Middle Name:L
Last Name:BALTIMORE
Suffix:
Gender:F
Credentials:PLMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 LOTHROP ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-1922
Mailing Address - Country:US
Mailing Address - Phone:402-708-0204
Mailing Address - Fax:402-342-6199
Practice Address - Street 1:1941 S 42ND ST
Practice Address - Street 2:STE 430
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2939
Practice Address - Country:US
Practice Address - Phone:402-342-6197
Practice Address - Fax:402-342-6199
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-367101YA0400X
NE7241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health