The Body Image Therapy Center LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

15245 Issued in MD

Legal business name

THE BODY IMAGE THERAPY CENTER LLC

Practice address

8940 Old Annapolis Rd
Suite E
Columbia, MD 21045-2129

Phone

(443) 602-6515

Fax

(443) 546-1100

NPI assigned

Jun 30, 2011

Organization subpart

No

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

Authorized official

Name

Andrew Walen, LCSW-C

Title

Owner, Executive Director

Phone

(443) 602-6515

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309392000000",
    "number": "1609163450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8940 OLD ANNAPOLIS RD",
            "address_2": "SUITE E",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452129",
            "telephone_number": "443-602-6515",
            "fax_number": "443-546-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8940 OLD ANNAPOLIS RD",
            "address_2": "SUITE E",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452129",
            "telephone_number": "443-602-6515",
            "fax_number": "443-546-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BODY IMAGE THERAPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-30",
        "last_updated": "2011-06-30",
        "status": "A",
        "authorized_official_last_name": "WALEN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER, EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "443-602-6515",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC3911",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "15245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vyoma Thakor, PT, DPT
• Theresa Katharine Thaler
• Saw Clayton Than
• Deborah A Thatcher-Wilson, DDS
• Sheeba Shaju Thattil, NP
• The Bridge Therapeutic & Evaluation Services, LLC
• The Cedar Health Group LLC
• The Center for Integrated Manual Therapies LLC
• The Children'S Spot
• The Dental Office of Nathaniel Fogel, DDS LLC. (Pineview Dental)

• Clinical Social Worker in Columbia, MD
• Providers in Columbia, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2011; 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.