NPIMap

Organization Active NPI

Family Service Foundation, Inc

  • Rehabilitation Psychologist
  • Frederick, MD
National Provider Identifier
1093039182
Registry record updated Sep 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation PsychologistTaxonomy code 103TR0400X
License
4163 Issued in MD
Legal business name
FAMILY SERVICE FOUNDATION, INC
Practice address
306 Delaware Road
Frederick, MD 21701-4618
Phone
(301) 378-0261
Fax
(301) 378-0267
NPI assigned
Mar 18, 2010
Last updated
Sep 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2012

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

Authorized official

Name
Daphne Smith
Title
Billing Manager
Phone
(301) 459-2121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TR0400X 4163 MD Primary

Addresses

Primary practice location

306 Delaware Road
Frederick, MD 21701-4618

Mailing address

5301 76TH Ave
Landover Hills, MD 20784-1703
Phone (301) 459-2121

Other identifiers 1

IdentifierTypeStateIssuer
320741200MedicaidMD

Other names 1

  • FAMILY SERVICE OF PRINCE GEORGES COUNTY, INC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Family Service Foundation Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348012800000",
    "number": "1093039182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 76TH AVE",
            "city": "LANDOVER HILLS",
            "state": "MD",
            "postal_code": "207841703",
            "telephone_number": "301-459-2121",
            "fax_number": "301-918-9757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 DELAWARE ROAD",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217014618",
            "telephone_number": "301-378-0261",
            "fax_number": "301-378-0267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY SERVICE FOUNDATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-18",
        "last_updated": "2012-09-19",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DAPHNE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "301-459-2121"
    },
    "taxonomies": [
        {
            "code": "103TR0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Rehabilitation",
            "state": "MD",
            "license": "4163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "320741200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY SERVICE OF PRINCE GEORGES COUNTY, INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; 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.