Active NPI
Maryann Etukudo
- Mental Health Counselor
- Laurel, MD
National Provider Identifier
1073115358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 14625 Baltimore Ave # 817
Laurel, MD 20707-4902 - Phone
- (240) 806-8401
- NPI assigned
- Nov 12, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
14625 Baltimore Ave # 817
Laurel, MD 20707-4902
Mailing address
14625 Baltimore Ave # 817
Laurel, MD 20707-4902
Phone (240) 806-8401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2018
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
14300 Cherry Lane CT
Laurel, MD 20707-4958
35 Newgate Cir
Smyrn, DE 19977-4039
5632 Whitfield Chapel Rd
Apt 203
Lanham, MD 20706-2554
8201 Corporate Dr
Suite 630
Hyattsville, MD 20785-2258
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
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.
-
- Psychiatric/Mental Health Nurse Practitioner
- Laurel, MD
- NPI 1588438196
DC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605139200000",
"number": "1073115358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14625 BALTIMORE AVE # 817",
"city": "LAUREL",
"state": "MD",
"postal_code": "207074902",
"telephone_number": "240-806-8401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14625 BALTIMORE AVE # 817",
"city": "LAUREL",
"state": "MD",
"postal_code": "207074902",
"telephone_number": "240-806-8401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETUKUDO",
"first_name": "MARYANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-12",
"last_updated": "2020-11-12",
"certification_date": "2020-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laurel, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; 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.