Provider Demographics
NPI:1053748996
Name:THE FAMILY GARDEN LLC
Entity type:Organization
Organization Name:THE FAMILY GARDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISCHBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-212-8125
Mailing Address - Street 1:6528 BALLYMORE LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1292
Mailing Address - Country:US
Mailing Address - Phone:443-212-8125
Mailing Address - Fax:
Practice Address - Street 1:6528 BALLYMORE LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1292
Practice Address - Country:US
Practice Address - Phone:443-212-8125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD099471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty