BROOK LANE BEHAVIORAL SERVICES, INC. (NPI# 1538657630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538657630 |
| Entity Type | Organization |
| Organization Name | BROOK LANE BEHAVIORAL SERVICES, INC. |
| Practice Address |
5301 Buckeystown Pike Frederick MD 21704-8370 |
| Mailing Address |
13121 Brook Lane Hagerstown MD 21742 |
| Practice Telephone | 3017330330 |
| Practice Fax Number | 3017334038 |
| Mailing Telephone | 3017330330 |
| Mailing Fax Number | 3017334038 |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2018-10-01 |
| Authorized Official Name | JAMIE LEA BARKDOLL (CRED COORDINATOR) |
| Authorized Official Telephone | 3017330331 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
BH000027 | MD | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558648410 | Brook Lane Behavioral Services, Inc. | Psychiatric Hospital | 4540b Mack Avenue, Frederick, MD 21701 | 2011-11-07 |
| 1144703109 | Brook Lane Behavioral Services, Inc. | Psychiatric Hospital | 13215 Brook Lane, Hagerstown, MD 21742-1495 | 2018-09-14 |
| 1962985929 | Brook Lane Behavioral Services, Inc. | Psychiatric Unit | 13215 Brook Lane, Hagerstown, MD 21742 | 2018-09-14 |
| 1538647748 | Brook Lane Behavioral Services, Inc. | Counselor | 13215 Brook Lane, Outpatient Services, Hagerstown, MD 21742 | 2018-07-31 |
| 1003304106 | Brook Lane Behavioral Services, Inc. | Clinic/Center | 18714 N Village, Hagerstown, MD 21742-2454 | 2018-04-25 |
| 1871983320 | Brook Lane Behavioral Services, Inc. | Counselor | 4540 B-d Mack Ave, Frederick, MD 21701 | 2015-02-04 |
| 1063721512 | Brook Lane Behavioral Services, Inc. | Clinic/Center | 5301 Buckeystown Pike, Suite 170, Frederick, MD 21704-8370 | 2010-10-01 |
| 1417928151 | Brook Lane Behavioral Services, Inc. | Clinic/Center | 18714 N Village, Shopping Center, Hagerstown, MD 21742-2454 | 2006-01-31 |
| Street Address |
5301 BUCKEYSTOWN PIKE |
| City | FREDERICK |
| State | MD |
| Zip Code | 21704-8370 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972584233 | Andrew B. Johnson | Psychiatry & Neurology | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2005-11-14 |
| 1366093098 | Shannon Snowman | Student in an Organized Health Care Education/Training Program | 5301 Buckeystown Pike, Stet 170, Frederick, MD 21704 | 2019-09-24 |
| 1649624198 | Mary Noble | Counselor | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2016-04-21 |
| 1558715185 | Melissa Crigger | Counselor | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2016-04-20 |
| 1174986558 | Marta Menendez-voss | Social Worker | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2016-04-01 |
| 1942688379 | Evan Nathan Dickstein | Registered Nurse | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2015-05-18 |
| 1962890962 | Emily Collingham | Counselor | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2014-12-30 |
| 1518361690 | Maria Murphy | Counselor | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2014-10-17 |
| 1932511714 | James Arthur Schiller | Social Worker | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2014-05-28 |
| 1952729568 | Samantha Elizabeth Wilt | Social Worker | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2014-04-01 |
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|---|---|---|---|---|
| 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 |
| 1104352368 | Mentor-maryland | Community/Behavioral Health | 5970 Frederick Crossing Lane, #202, Frederick, MD 21704 | 2017-05-10 |
| 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 |
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| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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|---|---|---|---|---|
| 1730277435 | Maryland Treatment Centers, Inc. | Clinic/Center | 174 Thomas Johnson Dr Ste 101, Frederick, MD 21702-4571 | 2006-10-10 |
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| 1780107631 | Concerted Care Group Frederick LLC | Clinic/Center | 300 Scholls Ln, Frederick, MD 21701-6380 | 2017-07-24 |
| 1215395298 | Terry Jane Austin | Clinic/Center | 27 W 7th St, Frederick, MD 21701-4689 | 2016-02-04 |
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| 1992027726 | Serenity Treatment Center, Inc. | Clinic/Center | 420 E Patrick St, Frederick, MD 21701-5658 | 2010-02-21 |
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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.