MENTOR-MARYLAND (NPI# 1104352368) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104352368 |
| Entity Type | Organization |
| Organization Name | MENTOR-MARYLAND |
| Practice Address |
5970 Frederick Crossing Lane #202 Frederick MD 21704 |
| Mailing Address |
5720 Executive Drive Catonsville MD 21228 |
| Practice Telephone | 3015240977 |
| Mailing Telephone | 4104554600 |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2017-05-10 |
| Authorized Official Name | DR. CAROL IVY SIMMONS (DIRECTOR, OMHC) |
| Authorized Official Telephone | 4104554600 |
| Authorized Official Credential | PH.D., LCSW-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | MH-2279 | MD | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 056668 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023544285 | Mentor-maryland | Community/Behavioral Health | 4200 Forbes Boulevard, Suite 100, Lanham, MD 20706 | 2017-05-10 |
| 1588190748 | Mentor-maryland | Community/Behavioral Health | 1540 Caton Center Drive, Halethorpe, MD 21227 | 2017-05-10 |
| 1750817912 | Mentor-maryland | Community/Behavioral Health | 620 West Naylor Mill Road, Suite A-f, Salisbury, MD 21801 | 2017-05-10 |
| Street Address |
5970 FREDERICK CROSSING LANE #202 |
| City | FREDERICK |
| State | MD |
| Zip Code | 21704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144747148 | Danah Jack | Physical Therapist | 4070 Atterbury Place, Frederick, MD 21704 | 2017-08-29 |
| 1568986891 | Amy Benjamin Slp | Speech-Language Pathologist | 8905 Amelung St, Frederick, MD 21704 | 2017-07-28 |
| 1699193284 | Jiang Tan | Acupuncturist | 3520 Worthington Blvd #101, Frederick, MD 21704 | 2014-04-01 |
| 1326460817 | Jessica Lacayo | Nurse Practitioner | 3350 Worthington Boulevard, Urbana, MD 21704 | 2014-01-17 |
| 1588098818 | Kimberly Kaye Dipietro | Registered Nurse | 9006 Harris Street, Frederick, MD 21704 | 2013-08-22 |
| 1831432525 | Yuqing Meng | Pharmacist | 9317 Elgin Lane, Frederick, MD 21704 | 2013-04-01 |
| 1831446285 | Diane Marie Foland | Behavioral Analyst | 4235 Lafayette Street, Frederick, MD 21704 | 2012-08-03 |
| 1982932695 | Contemporary Therapeutic Services Inc | Community/Behavioral Health | 22 N Potomac Street, Ste 102, Hagerstown, MD 21704 | 2009-11-19 |
| 1942461181 | Hoa T K Lam | Dentist | 7360 Guilford Drive, Suite #102, Frederick, MD 21704 | 2008-06-20 |
| 1184817512 | Frederick Medical & Pulmonary Assoc | Specialist | 7115 Guilford Drive #202, Frederick, MD 21704 | 2007-08-20 |
| Find all providers in zip 21704 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518577170 | Connie Wesley Lcmft LLC | Community/Behavioral Health | 111 Holling Dr, Frederick, MD 21701-5051 | 2020-08-07 |
| 1609495381 | Kema Health Services | Community/Behavioral Health | 2083 Buell Dr, Frederick, MD 21702-3284 | 2020-04-13 |
| 1780215293 | Andrew Campbell Counseling, LLC | Community/Behavioral Health | 1 W Church St Ste 3, Frederick, MD 21701-5992 | 2020-02-03 |
| 1689180119 | Harwood Behavioral Health Partners, LLC | Community/Behavioral Health | 300 B Scholls Lane, Frederick, MD 21701 | 2017-12-20 |
| 1861917395 | Child Quest LLC | Community/Behavioral Health | 5716 Industry Ln Ste G, Frederick, MD 21704-5201 | 2017-08-05 |
| 1467983171 | Aaron Todd Heaton Psychologist | Community/Behavioral Health | 365 W Patrick St, Suite 205, Frederick, MD 21701-4854 | 2017-03-23 |
| 1609326842 | Family Support Services | Community/Behavioral Health | 300 W. Patrick St, Frederick, MD 21701-4914 | 2016-10-12 |
| 1245603802 | Way Station, Inc. | Community/Behavioral Health | 10304 Putman Rd, Frederick, MD 21702-1838 | 2015-11-04 |
| 1487082293 | Btst Services LLC | Community/Behavioral Health | 7190 Crestwood Blvd Ste 400, Frederick, MD 21703-7318 | 2013-10-15 |
| 1669713509 | Blb Counseling | Community/Behavioral Health | 65 Thomas Johnson Dr Ste A, Frederick, MD 21702-4371 | 2013-03-01 |
| Find all providers in FREDERICK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.