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Organization

THE HOUSE OF THE GOOD SHEPHERD OF THE CITY OF BALTIMORE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DERRICK A. BOONE PSY.D. (PRESIDENT & CEO)
(410) 247-2770
Entity
Organization

Contact information

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

Taxonomy

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

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
427825900
MD
Enumeration date
03/19/2007
Last updated
05/13/2009
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