Individual provider Active NPI

Cynthia Reagle, LCSW-C

  • Clinical Social Worker
  • Elkton, MD
National Provider Identifier
1194129130
Registry record updated May 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
16765 Issued in MD
Practice address
200 Booth St
Elkton, MD 21921-5657
Phone
(410) 996-3400
NPI assigned
Oct 20, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 16765 MD Primary

Addresses

Primary practice location

200 Booth St
Elkton, MD 21921-5657

Mailing address

200 Booth St
Elkton, MD 21921-5657
Phone (410) 996-3400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150824000924 MD Practitioner - Clinical Social Worker 0244545028 Reassigns benefits to 1 organization
Practice locations: North East, MD; Rising Sun, MD

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Rising Sun, MD 21911
Phone (443) 350-3773

2057 Pulaski Hwy
Suite 4
North East, MD 21901-3744
Phone (443) 350-3773

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16765MDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Upper Bay Counseling and Support Services, Inc CurrentSince Jul 29, 2015 Accepting new patients
Upper Bay Counseling & Support Services, Inc. CurrentSince Jul 29, 2015 Accepting new patients
Jesse Fairchild LLC Clinical PastSince Mar 28, 2014 Accepting new patients

Locations

200 Booth St
Elkton, MD 21921
Phone (410) 996-3400

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1413763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432684800000",
    "number": "1194129130",
    "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": "410-996-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BOOTH ST",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219215657",
            "telephone_number": "410-996-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REAGLE",
        "first_name": "CYNTHIA",
        "credential": "LCSW-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-20",
        "last_updated": "2015-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "16765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkton, MD

Sources for this page

Verify at the official NPI Registry.