Organization Active NPI

From Broken

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baltimore, MD
National Provider Identifier
1205575396
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
FROM BROKEN
Practice address
1400 W. Lombard St Ste a #2071
Baltimore, MD 21223
Phone
(410) 707-4632
NPI assigned
May 27, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Anders L North, LCSWNPI 1629723994
Title
Ceo
Phone
(410) 707-4632

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1400 W. Lombard St Ste a #2071
Baltimore, MD 21223

Mailing address

1400 W. Lombard St Ste a #2071
Baltimore, MD 21223
Phone (410) 707-4632

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698883200000",
    "number": "1205575396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 W. LOMBARD ST STE A #2071",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21223",
            "telephone_number": "410-707-4632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 W. LOMBARD ST STE A #2071",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21223",
            "telephone_number": "410-707-4632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FROM BROKEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-27",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A",
        "authorized_official_last_name": "NORTH",
        "authorized_official_first_name": "ANDERS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-707-4632",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.