Modinat Oluwatoyin Fagbenro, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R210603 Issued in MD

Practice address

22 W Padonia Rd Ste C252
Lutherville Timonium, MD 21093-2241

Phone

(410) 768-6088

Fax

(410) 768-6444

NPI assigned

Sep 11, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mandm Behavioral Health SystemsGroup PAC ID 8224457528, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• M&M Behavioral Health Systems

  • Psychiatric/Mental Health Nurse Practitioner
  • Lutherville Timonium, MD
  • NPI 1881219848
  Medicare reassignment Care Compare group NPD
• Harmony Counceling Center Inc

  • Mental Health Counselor
  • Nottingham, MD
  • NPI 1861981276
  Medicare reassignment NPD

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

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768867200000",
    "number": "1063061034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4105 DAYLILY DR",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211175034",
            "telephone_number": "410-800-4471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 W PADONIA RD STE C252",
            "city": "LUTHERVILLE TIMONIUM",
            "state": "MD",
            "postal_code": "210932241",
            "telephone_number": "410-768-6088",
            "fax_number": "410-768-6444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4105 Daylily Dr",
            "address_purpose": "LOCATION",
            "city": "Owings Mills",
            "state": "MD",
            "postal_code": "211175034",
            "country_code": "US",
            "telephone_number": "410-800-4471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAGBENRO",
        "first_name": "MODINAT",
        "middle_name": "OLUWATOYIN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-11",
        "last_updated": "2026-01-20",
        "certification_date": "2026-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R210603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janice Eisele
• Endodontic Partners LLC
• Eric Klein DMD LLC
• Susan W Ettinger, MSN,NPC
• Eye Care Associates of MD, LLC
• Sokhena Fall
• Leila Fazeli
• Adele Cecilia Feild, LCPC
• Mark David Fersch, DO
• Kelley Morgan Finck, AU.D.

• Psychiatric/Mental Health Nurse Practitioner in Lutherville Timonium, MD
• Providers in Lutherville Timonium, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.