NPIMap

Organization Active NPI

Eastern Shore Psychological Services, LLC

  • Community/Behavioral Health Agency
  • Chestertown, MD
National Provider Identifier
1093164766
Registry record updated Sep 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EASTERN SHORE PSYCHOLOGICAL SERVICES, LLC
Practice address
315 High St Ste 201
Chestertown, MD 21620-1350
Phone
(410) 334-6961
NPI assigned
Jun 3, 2016
Last updated
Sep 20, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
EASTERN SHORE PSYCHOLOGICAL SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 20, 2016

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

Authorized official

Name
Cathy K Burkhard
Title
Esps Billing Supervisor & Credentia
Phone
(410) 334-6961

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

315 High St Ste 201
Chestertown, MD 21620-1350

Mailing address

2336 Goddard Pkwy
Salisbury, MD 21801-1126
Phone (410) 334-6961

Other identifiers 1

IdentifierTypeStateIssuer
609500304MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Eastern Shore Psychological Service8 organizations share this tax ID, including this one
Part of
Eastern Shore Psychological Service

Other organizations with this tax ID 7

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474329600000",
    "number": "1093164766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2336 GODDARD PKWY",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218011126",
            "telephone_number": "410-334-6961",
            "fax_number": "410-334-6362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 HIGH ST STE 201",
            "city": "CHESTERTOWN",
            "state": "MD",
            "postal_code": "216201350",
            "telephone_number": "410-334-6961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EASTERN SHORE PSYCHOLOGICAL SERVICES, LLC",
        "enumeration_date": "2016-06-03",
        "last_updated": "2016-09-20",
        "status": "A",
        "authorized_official_last_name": "BURKHARD",
        "authorized_official_first_name": "CATHY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ESPS BILLING SUPERVISOR & CREDENTIA",
        "authorized_official_telephone_number": "410-334-6961"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "609500304",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chestertown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2016; 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.