Provider Demographics
NPI:1861749319
Name:LUTHERAN MISSION SOCIETY OF MARYLAND
Entity type:Organization
Organization Name:LUTHERAN MISSION SOCIETY OF MARYLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIEPENTROG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW-C
Authorized Official - Phone:410-636-0123
Mailing Address - Street 1:601 HAMMONDS LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3330
Mailing Address - Country:US
Mailing Address - Phone:410-636-0123
Mailing Address - Fax:410-636-6984
Practice Address - Street 1:601 HAMMONDS LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-3330
Practice Address - Country:US
Practice Address - Phone:410-636-0123
Practice Address - Fax:410-636-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD815091OtherVALUE OPTIONS
MD600782589OtherMAGELLAN
MDAV09OtherBCBS CAREFIRST OF MD