NPIMap

Organization Active NPI

Upper Bay Counseling and Support Services, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Havre de Grace, MD
National Provider Identifier
1114252020
Registry record updated Jul 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
UPPER BAY COUNSELING AND SUPPORT SERVICES, INC
Practice address
626 Revolution St
Havre de Grace, MD 21078-3320
Phone
(410) 939-8744
Fax
(410) 939-8748
NPI assigned
Oct 9, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2021

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

Authorized official

Name
Mrs. Suanne Blumberg, LCPC
Title
Ceo
Phone
(410) 996-5104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

626 Revolution St
Havre de Grace, MD 21078-3320

Mailing address

200 Booth St
Elkton, MD 21921-5657
Phone (410) 996-5104

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040121000129 MD Part B Supplier - Clinic/Group Practice 3971405085 Receives reassigned benefits from 31 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Havre de Grace, MD; North East, MD; Elkton, MD

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Upper Bay Counseling Support Services Inc22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Locations

626 Revolution St
Havre de Grace, MD 21078
Phone (410) 939-8744

806 S Union Ave
Hvre de Grace, MD 21078
Phone (410) 939-8744

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1255046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626220800000",
    "number": "1114252020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BOOTH ST",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219215657",
            "telephone_number": "410-996-5104",
            "fax_number": "410-996-5197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 REVOLUTION ST",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783320",
            "telephone_number": "410-939-8744",
            "fax_number": "410-939-8748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER BAY COUNSELING AND SUPPORT SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-09",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A",
        "authorized_official_last_name": "BLUMBERG",
        "authorized_official_first_name": "SUANNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-996-5104",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Havre de Grace, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.