Provider Demographics
NPI:1841702321
Name:MARYLAND CHILDREN'S INSTITUTE, INC.
Entity type:Organization
Organization Name:MARYLAND CHILDREN'S INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF, CLINICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:IMAMU
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, LCPC, NCC, DCC
Authorized Official - Phone:410-622-2908
Mailing Address - Street 1:859 1/2 N HOWARD ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4696
Mailing Address - Country:US
Mailing Address - Phone:410-622-2908
Mailing Address - Fax:
Practice Address - Street 1:859 1/2 N HOWARD ST FL 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4696
Practice Address - Country:US
Practice Address - Phone:410-622-2908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health