NPIMap

Organization Active NPI

Mentor-Maryland

  • Community/Behavioral Health Agency
  • Frederick, MD
National Provider Identifier
1104352368
Registry record updated May 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MH-2279 Issued in MD
Legal business name
MENTOR-MARYLAND
Practice address
5970 Frederick Crossing Lane
#202
Frederick, MD 21704
Phone
(301) 524-0977
NPI assigned
May 10, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2017

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

Authorized official

Name
Dr. Carol Ivy Simmons, PH.D., LCSW-C
Title
Director, Omhc
Phone
(410) 455-4600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MH-2279 MD Primary

Addresses

Primary practice location

5970 Frederick Crossing Lane
#202
Frederick, MD 21704

Mailing address

5720 Executive Drive
Catonsville, MD 21228
Phone (410) 455-4600

Other identifiers 1

IdentifierTypeStateIssuer
056668MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Mentor-Maryland6 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.

Locations

5970 Frederick Crossing Ln
Ste 202
Frederick, MD 21704
Phone (301) 524-0977

NPI Registry JSON

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

{
    "created_epoch": "1494374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494374400000",
    "number": "1104352368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5720 EXECUTIVE DRIVE",
            "city": "CATONSVILLE",
            "state": "MD",
            "postal_code": "21228",
            "telephone_number": "410-455-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5970 FREDERICK CROSSING LANE",
            "address_2": "#202",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "21704",
            "telephone_number": "301-524-0977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTOR-MARYLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-10",
        "last_updated": "2017-05-10",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "IVY",
        "authorized_official_title_or_position": "DIRECTOR, OMHC",
        "authorized_official_telephone_number": "410-455-4600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., LCSW-C"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MD",
            "license": "MH-2279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "056668",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 May 10, 2017; 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.