Christina Benboudiaf
Individual provider Active NPI Mental Health Counselor · Edgewood, MD
NPI 1124414263 · NPPES record last updated Jan 15, 2024
Key facts
- NPI
- 1124414263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- P00111 (NY)
- Practice address
- 1434 Harford Square Dr
Edgewood, MD 21040-2212 - Phone
- (716) 261-9488
- NPI assigned
- Apr 15, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Maryland Wellness LLC
Practice addresses (Care Compare)
4128 Hayward Ave
Suite W
Baltimore, MD 21215-4340
Phone (410) 314-1030
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251204003180 | MD | Practitioner - Mental Health Counselor | 8224521521 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P00111 | NY | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maryland Wellness LLC | Current |
Accepting new patients | |
| Maryland Wellness LLC | Current |
Accepting new patients |
Locations
4128 Hayward Ave
Ste W
Baltimore, MD 21215
Phone (410) 241-6317
Interoperability endpoints
- christina.benboudiaf.p1@direct.mdwellness.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | P00111 | NY | Yes |
Addresses
Primary practice location
1434 Harford Square Dr
Edgewood, MD 21040-2212
Mailing address
206 S Elmwood Ave
Buffalo, NY 14201-2398
Phone (716) 847-2441
Other providers in Edgewood, MD
- Avawell, LLC
- Hilda Tifu Azong
- Kionna Barnes
- Jennifer Tracy Bartlebaugh
- Behavioral Health Connections
- Kim Bennett-Selby
- Cecilia Lariba Bibio
- Amanda Louise Boblitz-McFadden
- Emily Boyd
- Patrice Merle Boykin
All providers in Edgewood, MD · Mental Health Counselor in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.