| Organization Name: | MAIN STREET MOBILE TREATMENT |
| NPI Number: | 1194874867 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAMALA SOBOL RYAN (EXECUTIVE DIRECTOR) |
| Mailing Address: | 37 Main St Reisterstown |
| State: | MD US |
| Postal Code: | 211361236 |
| Phone Number: | 4105267882 |
| Fax Number: | 4105269855 |
| NPI Enumeration Date: | 01/10/2007 |
| NPI Last Update Date: | 07/26/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |