NPIMap

Organization Active NPI

Evergreen Mental Health Services, Inc.

  • Psychiatry Physician
  • Gaithersburg, MD
National Provider Identifier
1114236692
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
EVERGREEN MENTAL HEALTH SERVICES, INC.
Practice address
9318 Gaither Rd Ste 220
Gaithersburg, MD 20877-1407
Phone
(240) 251-4702
Fax
(301) 251-4703
NPI assigned
Sep 30, 2010
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Barton Paul Azwalinsky
Title
Ceo
Phone
(301) 251-4702

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Psychologist 103T00000X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

9318 Gaither Rd Ste 220
Gaithersburg, MD 20877-1407

Mailing address

9318 Gaither Rd Ste 220
Gaithersburg, MD 20877-1407
Phone (240) 251-4702

Other names 1

  • Life Skills/Rockville Other name

National Provider Directory

National Provider Directory

Locations

9318 Gaither Rd
Ste 220
Gaithersburg, MD 20877
Phone (301) 251-4702

9605 Medical Center Dr
Ste 270
Rockville, MD 20850
Phone (301) 251-4702

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

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": "1285804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1114236692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9318 GAITHER RD STE 220",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208771407",
            "telephone_number": "240-251-4702",
            "fax_number": "301-251-4703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9318 GAITHER RD STE 220",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208771407",
            "telephone_number": "240-251-4702",
            "fax_number": "301-251-4703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MENTAL HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "AZWALINSKY",
        "authorized_official_first_name": "BARTON",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-251-4702",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Skills/Rockville",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.