# THE HOUSE OF THE GOOD SHEPHERD OF THE CITY OF BALTIMORE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508980251
- **Authorized official:** DERRICK A. BOONE PSY.D. (PRESIDENT & CEO)
- **Authorized official phone:** (410) 247-2770

## Contact information

- **Practice address:** 4100 MAPLE AVENUE, BALTIMORE, MD 21227-4007
- **Practice address phone:** (410) 247-2770
- **Practice address fax:** (410) 247-3242
- **Mailing address:** 4100 MAPLE AVENUE, BALTIMORE, MD 21227-4007
- **Mailing address phone:** (410) 247-2770
- **Mailing address fax:** (410) 247-3242

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 03-049 | MD | Yes |

## Other

- **Enumeration date:** 03/19/2007
- **Last updated:** 05/13/2009