Provider Demographics
NPI:1952156150
Name:A BLENDED FAMILY MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:A BLENDED FAMILY MENTAL HEALTH SERVICES
Other - Org Name:ABF MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:QUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:443-703-8345
Mailing Address - Street 1:3214 E JOPPA RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3307
Mailing Address - Country:US
Mailing Address - Phone:443-703-8345
Mailing Address - Fax:
Practice Address - Street 1:3214 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-3307
Practice Address - Country:US
Practice Address - Phone:443-703-8345
Practice Address - Fax:410-305-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty