NPIMap

Organization Active NPI

Long Integrated Psychiatric Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Middle River, MD
National Provider Identifier
1033878137
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
LONG INTEGRATED PSYCHIATRIC SERVICES LLC
Practice address
11560 Crossroads Cir Ste 102
Middle River, MD 21220-2885
Phone
(410) 508-0722
NPI assigned
Dec 16, 2021
Organization subpart
Yes
Parent organization
LONG INTEGRATED PSYCHIATRIC SERVICES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Authorized official

Name
Angela Desiree LongNPI 1720458706
Title
Owner
Phone
(410) 508-0722

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

11560 Crossroads Cir Ste 102
Middle River, MD 21220-2885

Mailing address

7652 Belair Rd Ste a
Baltimore, MD 21236-4067

Other practice location 1

1101 N Point Blvd Ste 131
Baltimore, MD 21224-3417
Phone (410) 508-0722

Other practice location 2

260 Gateway Dr # 13-14A
Bel Air, MD 21014-4268
Phone (410) 508-0722

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210426000026 MD Part B Supplier - Clinic/Group Practice 9436567831 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baltimore, MD; Middle River, MD

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Long Integrated Psych Serv4 organizations share this tax ID, including this one
Part of
Long Integrated Psych Serv

Other organizations with this tax ID 3

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

Locations

1101 N Point Blvd
Ste 131
Baltimore, MD 21224
Phone (410) 508-0722

260 Gateway Dr
#1314A
Bel Air, MD 21014
Phone (410) 508-0722

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1639612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1033878137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7652 BELAIR RD STE A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212364067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11560 CROSSROADS CIR STE 102",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212202885",
            "telephone_number": "410-508-0722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 N Point Blvd Ste 131",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212243417",
            "country_code": "US",
            "telephone_number": "410-508-0722",
            "fax_number": "410-834-1851",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "260 Gateway Dr # 13-14A",
            "address_purpose": "LOCATION",
            "city": "Bel Air",
            "state": "MD",
            "postal_code": "210144268",
            "country_code": "US",
            "telephone_number": "410-508-0722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LONG INTEGRATED PSYCHIATRIC SERVICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LONG INTEGRATED PSYCHIATRIC SERVICES LLC",
        "enumeration_date": "2021-12-16",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "DESIREE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-508-0722"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middle River, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; 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.