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Organization

MOSAIC COMMUNITY SERVICES-NBC-MT

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JEFF RICHARDSON LCSW-C (EXECUTIVE DIRECTOR)
(410) 453-9553
Entity
Organization

Contact information

Practice address
2225 N CHARLES ST, BALTIMORE, MD 21218-5778
(410) 366-4360
(410) 308-8926
Mailing address
1925 GREENSPRING DR, TIMONIUM, MD 21093-4128
(410) 453-9553
(410) 308-8926

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
4645
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4645
DHMH LICENSE
MD
Enumeration date
05/28/2010
Last updated
05/28/2010
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