NPIMap

Organization Active NPI

Coquus

  • Psychologist
  • Waldorf, MD
National Provider Identifier
1205079746
Registry record updated Jun 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
02983 Issued in MD
Legal business name
COQUUS
Practice address
21 Industrial Park Dr
Suite 202 F
Waldorf, MD 20602-2751
Phone
(301) 848-0461
Fax
(301) 885-0922
NPI assigned
Apr 14, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2009

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

Authorized official

Name
Dr. Patricia Vance, PH.D.NPI 1518082478
Title
Director
Phone
(301) 848-0461

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 02983 MD Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 05567 MD

Addresses

Primary practice location

21 Industrial Park Dr
Suite 202 F
Waldorf, MD 20602-2751

Mailing address

21 Industrial Park Dr
Suite 202 F
Waldorf, MD 20602-2751
Phone (301) 848-0461

Other names 1

  • Vance Mental Health Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090701000530 MD Part B Supplier - Clinic/Group Practice 9638220759 Receives reassigned benefits from 2 practitioners
Practice locations: Waldorf, MD

National Provider Directory

National Provider Directory

Locations

601 Post Office Rd
Ste 2B
Waldorf, MD 20602
Phone (301) 848-0461

21 Industrial Park Dr
Ste 202F
Waldorf, MD 20602
Phone (301) 848-0461

601 Post Office Rd
Ste 2D
Waldorf, MD 20602
Phone (301) 848-0461

21 Industrial Park Dr
Ste 202
Waldorf, MD 20602
Phone (301) 848-0461

Practitioners & affiliated clinicians

Practitioners 8

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": "1239667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245801600000",
    "number": "1205079746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 INDUSTRIAL PARK DR",
            "address_2": "SUITE 202 F",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206022751",
            "telephone_number": "301-848-0461",
            "fax_number": "301-885-0922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 INDUSTRIAL PARK DR",
            "address_2": "SUITE 202 F",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206022751",
            "telephone_number": "301-848-0461",
            "fax_number": "301-885-0922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COQUUS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-14",
        "last_updated": "2009-06-24",
        "status": "A",
        "authorized_official_last_name": "VANCE",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "301-848-0461",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MD",
            "license": "02983",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "05567",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vance Mental Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 24, 2009; 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.