Provider Demographics
NPI:1891007738
Name:PBMJ ASSOCIATES
Entity Type:Organization
Organization Name:PBMJ ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC,CAC-AD
Authorized Official - Phone:443-559-0450
Mailing Address - Street 1:PO BOX 19817
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MD
Mailing Address - Zip Code:21225-0317
Mailing Address - Country:US
Mailing Address - Phone:443-559-0450
Mailing Address - Fax:
Practice Address - Street 1:1 E MOUNT ROYAL AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2614
Practice Address - Country:US
Practice Address - Phone:443-559-0450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3506251B00000X, 251S00000X, 252Y00000X
MDLC30506302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419828000Medicaid