Organization Active NPI

Make It Possible, LLC

  • Clinical Psychologist
  • Waldorf, MD
National Provider Identifier
1124888656
Registry record updated Mar 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
MAKE IT POSSIBLE, LLC
Practice address
2255 Crain Hwy
Suite 202
Waldorf, MD 20601
Phone
(757) 803-6399
NPI assigned
Mar 21, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2024

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

Authorized official

Name
Amarilys Galloza Carrero, PH.D.NPI 1558146373
Title
Clinical Psychologist
Phone
(757) 803-6399

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

2255 Crain Hwy
Suite 202
Waldorf, MD 20601

Mailing address

440 Monticello Ave Ste 1802
PMB 936995
Norfolk, VA 23510-2670
Phone (757) 803-6399

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240723001017 MD Part B Supplier - Clinic/Group Practice 9133665490 Receives reassigned benefits from 1 practitioner
Practice locations: Waldorf, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1710979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710979200000",
    "number": "1124888656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 MONTICELLO AVE STE 1802",
            "address_2": "PMB 936995",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235102670",
            "telephone_number": "757-803-6399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 CRAIN HWY",
            "address_2": "SUITE 202",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "20601",
            "telephone_number": "757-803-6399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAKE IT POSSIBLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-21",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A",
        "authorized_official_last_name": "GALLOZA CARRERO",
        "authorized_official_first_name": "AMARILYS",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "757-803-6399",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2024; 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.