NPIMap

Organization Active NPI

Maryland Wellness LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baltimore, MD
National Provider Identifier
1003479668
Registry record updated Apr 16, 2025
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
MARYLAND WELLNESS LLC
Practice address
4128 Hayward Ave # W
Baltimore, MD 21215-4340
Phone
(410) 994-6491
NPI assigned
Apr 19, 2019
Last updated
Apr 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Authorized official

Name
Sierra Burley
Title
Credentialing Specialist
Phone
(410) 314-1030

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Group Psychotherapy PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TP2701X
Case Management Agency 251B00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

4128 Hayward Ave # W
Baltimore, MD 21215-4340

Mailing address

4128 Hayward Ave # W
Baltimore, MD 21215-4340
Phone (410) 994-6491

Other practice location 1

519 N Mechanic St
Cumberland, MD 21502-2133
Phone (410) 241-6317

Other practice location 2

2255 Crain Hwy Ste 106
Waldorf, MD 20601-3186
Phone (410) 241-6317

Other practice location 3

4500 Black Rock Rd # G2
Hampstead, MD 21074-2636
Phone (410) 241-6317

Other practice location 4

117 E Main St
Westminster, MD 21157-5012
Phone (410) 241-6317

Other practice location 5

920 W Washington St Ste 201
Hagerstown, MD 21740-2803
Phone (410) 241-6317

Other practice location 6

4200 Forbes Blvd Ste 104
Lanham, MD 20706-4872
Phone (410) 241-6317

Other practice location 7

8 Church Ln # W
Pikesville, MD 21208-3721
Phone (410) 241-6317

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200611002298 MD Part B Supplier - Clinic/Group Practice 6406278803 Receives reassigned benefits from 28 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baltimore, MD; Cumberland, MD; Hagerstown, MD; Waldorf, MD

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Maryland Wellness LLC39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Locations

4500 Black Rock Rd
#G2
Hampstead, MD 21074
Phone (410) 241-6317

8 Church Ln
Pikesville, MD 21208
Phone (410) 241-6317

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1555632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744761600000",
    "number": "1003479668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4128 HAYWARD AVE # W",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212154340",
            "telephone_number": "410-994-6491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4128 HAYWARD AVE # W",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212154340",
            "telephone_number": "410-994-6491"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "519 N Mechanic St",
            "address_purpose": "LOCATION",
            "city": "Cumberland",
            "state": "MD",
            "postal_code": "215022133",
            "country_code": "US",
            "telephone_number": "410-241-6317",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2255 Crain Hwy Ste 106",
            "address_purpose": "LOCATION",
            "city": "Waldorf",
            "state": "MD",
            "postal_code": "206013186",
            "country_code": "US",
            "telephone_number": "410-241-6317",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4500 Black Rock Rd # G2",
            "address_purpose": "LOCATION",
            "city": "Hampstead",
            "state": "MD",
            "postal_code": "210742636",
            "country_code": "US",
            "telephone_number": "410-241-6317",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "117 E Main St",
            "address_purpose": "LOCATION",
            "city": "Westminster",
            "state": "MD",
            "postal_code": "211575012",
            "country_code": "US",
            "telephone_number": "410-241-6317",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "920 W Washington St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Hagerstown",
            "state": "MD",
            "postal_code": "217402803",
            "country_code": "US",
            "telephone_number": "410-241-6317",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4200 Forbes Blvd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Lanham",
            "state": "MD",
            "postal_code": "207064872",
            "country_code": "US",
            "telephone_number": "410-241-6317",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8 Church Ln # W",
            "address_purpose": "LOCATION",
            "city": "Pikesville",
            "state": "MD",
            "postal_code": "212083721",
            "country_code": "US",
            "telephone_number": "410-241-6317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MARYLAND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-19",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A",
        "authorized_official_last_name": "BURLEY",
        "authorized_official_first_name": "SIERRA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "410-314-1030"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Apr 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.