Organization
JOHNS HOPKINS BAYVIEW MEDICAL CENTER
Active
Other names
Community Psychiatry - Off Site Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIFER NICKOLES (PRESIDENT)
(410) 955-6552
Entity
Organization
Contact information
Practice address
1821 PORTAL STREET, SUITE B, BALTIMORE, MD 21224-6518
(410) 550-0070
(410) 550-1061
Mailing address
PO BOX 632053, BALTIMORE, MD 21263-0001
(443) 997-0001
(443) 997-0011
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
30005
MD
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
30005
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006700801
—
MD
01
—
046611500
MA CONTRACTOR
—
01
—
58853110
MA CONTRACTOR
—
Enumeration date
12/15/2006
Last updated
07/11/2025
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