Provider Demographics
NPI:1205173192
Name:METROPOLITAN BREAKING THE CYCLE BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:METROPOLITAN BREAKING THE CYCLE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLETO
Authorized Official - Middle Name:AGUSTUS
Authorized Official - Last Name:LINTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC
Authorized Official - Phone:443-379-7055
Mailing Address - Street 1:2071 PARK TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1242
Mailing Address - Country:US
Mailing Address - Phone:443-379-7055
Mailing Address - Fax:443-450-3972
Practice Address - Street 1:17 WARREN RD
Practice Address - Street 2:SUITE 12-B
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5334
Practice Address - Country:US
Practice Address - Phone:443-379-7055
Practice Address - Fax:443-450-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA069251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health