Jacquelyn Deshong, LMFT
Individual provider Active NPI Marriage & Family Therapist · Bowie, MD
NPI 1124759766 · NPPES record last updated Jun 23, 2022
Key facts
- NPI
- 1124759766
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 001698-01 (NY)
- Practice address
- 16701 Melford Blvd
Bowie, MD 20715-4305 - Phone
- (844) 830-7233
- NPI assigned
- Jun 23, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Marriage and Family Therapist
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Truenorth Wellness Services
Practice addresses (Care Compare)
119 Lincolnway W
McConnellsburg, PA 17233-1302
Phone (717) 485-3264
53512 Jaycee Ave
Suite 1
Harrisburg, PA 17112
Phone (717) 632-4900
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- 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 |
|---|---|---|---|---|
| I20240605002120 | PA | Practitioner - Marriage and Family Therapist | 5496297467 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001698-01 | NY | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vita Health Services, LLPC | Current |
Accepting new patients | |
| Truenorth Wellness Services | Current |
Accepting new patients | |
| Truenorth Wellness Services | Current |
Accepting new patients | |
| Truenorth Wellness Services | Current | Accepting new patients | |
| Vita Health Services, PLLC | Marriage & Family Therapist | Past |
Accepting new patients |
Locations
4 Science Park
New Haven, CT 06511
Phone (203) 498-9706
625 W Elm Ave
Hanover, PA 17331
Interoperability endpoints
- https://api.platform.athenahealth.com/24036/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 001698-01 | NY | Yes |
Addresses
Primary practice location
16701 Melford Blvd
Bowie, MD 20715-4305
Mailing address
4 Science Park
New Haven, CT 06511-1962
Phone (844) 830-7233
Other practice location 1
401 Park Ave S
New York, NY 10016-8808
Phone (844) 830-7233
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- Alicia Derenoncourt
- Elisabeth Desir
- Desired Social Services, LLC
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All providers in Bowie, MD · Marriage & Family Therapist in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2022. 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.