NPIMap

Organization Active NPI

Kennedy Krieger Associates, Inc.

  • Clinical Child & Adolescent Psychologist
  • Baltimore, MD
National Provider Identifier
1053572958
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
30036 Issued in MD
Legal business name
KENNEDY KRIEGER ASSOCIATES, INC.
Practice address
707 N. Broadway
Baltimore, MD 21205
Phone
(443) 923-9200
Fax
(443) 923-9405
NPI assigned
Jun 23, 2008
Last updated
Sep 16, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
KENNEDY KRIEGER INSTITUTEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Authorized official

Name
Mr. Mike Neuman
Title
Vice President Finance
Phone
(443) 923-1810

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 30036 MD Primary

Addresses

Primary practice location

707 N. Broadway
Baltimore, MD 21205

Mailing address

P.O. Box 744865
Atlanta, GA 30374
Phone (443) 923-1886

Other identifiers 1

IdentifierTypeStateIssuer
414602600MedicaidMD

Other names 1

  • Kennedy Krieger Institute Other name

National Provider Directory

National Provider Directory
Tax ID family
Charles E Silberstein M15 organizations share this tax ID, including this one
Part of
Kennedy Krieger Childrens Hospital Inc

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1053572958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 744865",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30374",
            "telephone_number": "443-923-1886",
            "fax_number": "443-923-1895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N. BROADWAY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21205",
            "telephone_number": "443-923-9200",
            "fax_number": "443-923-9405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY KRIEGER ASSOCIATES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENNEDY KRIEGER INSTITUTE",
        "enumeration_date": "2008-06-23",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "NEUMAN",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "443-923-1810",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MD",
            "license": "30036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "414602600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kennedy Krieger Institute",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Kennedy Krieger Institute",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Sep 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.