Organization
SHEPPARD PRATT HEALTH SYSTEM, INC.
Active
Other names
Lodge School
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BONNIE B KATZ (VP CORPORATE BUSINESS DEVELOPMENT)
(410) 938-3150
Entity
Organization
Contact information
Practice address
610 E DIAMOND AVE, SUITE E, GAITHERSBURG, MD 20877-5321
(301) 208-0561
(301) 330-0533
Mailing address
6501 N CHARLES ST, BALTIMORE, MD 21204-6819
(419) 938-3000
(410) 938-3159
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
236
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
236
STATE LICENSE
MD
Enumeration date
01/22/2007
Last updated
01/16/2009
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