NPIMap

Organization Active NPI

Life Therapy Specialists of MD, LLC

  • Mental Health Counselor
  • Lutherville, MD
National Provider Identifier
1114225810
Registry record updated Mar 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LC2273 Issued in MD
Legal business name
LIFE THERAPY SPECIALISTS OF MD, LLC
Practice address
1927A York Rd
Lutherville, MD 21093-4225
Phone
(443) 417-4243
Fax
(315) 245-0352
NPI assigned
Mar 3, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2011

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

Authorized official

Name
Marie E Mastracco, LCPC
Title
President
Phone
(443) 417-4243

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X LC2273 MD Primary

Addresses

Primary practice location

1927A York Rd
Lutherville, MD 21093-4225

Mailing address

1927A York Rd
Lutherville, MD 21093-4225
Phone (443) 417-4243

Other identifiers 1

IdentifierTypeStateIssuer
922801200MedicaidMD

National Provider Directory

National Provider Directory

Locations

1927A York Rd
Lutherville, MD 21093
Phone (443) 417-4243

NPI Registry JSON

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

{
    "created_epoch": "1299110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299110400000",
    "number": "1114225810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1927A YORK RD",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210934225",
            "telephone_number": "443-417-4243",
            "fax_number": "315-245-0352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1927A YORK RD",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210934225",
            "telephone_number": "443-417-4243",
            "fax_number": "315-245-0352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE THERAPY SPECIALISTS OF MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-03",
        "last_updated": "2011-03-03",
        "status": "A",
        "authorized_official_last_name": "MASTRACCO",
        "authorized_official_first_name": "MARIE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "443-417-4243",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LC2273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "922801200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutherville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2011; 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.