1114148814 NPI number — FREDERICK COUNTY DEPT. SOCIAL SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114148814 NPI number — FREDERICK COUNTY DEPT. SOCIAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREDERICK COUNTY DEPT. SOCIAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114148814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 N KENT ST
Provider Second Line Business Mailing Address:
SUITE300
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-5039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 N KENT ST
Provider Second Line Business Practice Location Address:
SUITE300
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22601-5039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-665-5688
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
TAMARA
Authorized Official Middle Name:
Authorized Official Title or Position:
SOCIAL WORK SUPERVISOR
Authorized Official Telephone Number:
540-665-5688

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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