Individual provider Active NPI

Lilian Maboh

  • Psychiatric/Mental Health Nurse Practitioner
  • Washington, DC
National Provider Identifier
1215296157
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R217417 Issued in MD
Practice address
650 Pennsylvania Ave SE Ste 330
Washington, DC 20003-4397
Phone
(202) 864-4184
NPI assigned
May 13, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN1044197 DC
Community Psychiatric/Mental Health Clinical Nurse Specialist 364SP0812X NP1044197 DC
Home Health Aide 374U00000X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X R217417 MD Primary

Addresses

Primary practice location

650 Pennsylvania Ave SE Ste 330
Washington, DC 20003-4397

Mailing address

1818 New York Ave NE
228
Washington, DC 20002-1848
Phone (202) 832-8340

Other practice location 1

1818 New York Ave NE
228
Washington, DC 20002-1848
Phone (202) 832-8340

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240618003499 MD Practitioner - Nurse Practitioner 5597208561 Reassigns benefits to 2 organizations
I20240620000406 DC Practitioner - Nurse Practitioner 5597208561 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrahealth LLCGroup PAC ID 3678911625, 47 clinicians
Toller Enterprises, LLCGroup PAC ID 8628481926, 63 clinicians

Practice addresses (Care Compare)

200 Civic Ave
Salisbury, MD 21804-4599
Phone (410) 749-1466

3210 Powder Mill Rd
Hyattsville, MD 20783-1029
Phone (443) 452-9612

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN1044197DCMDRegistered Nurse
NP1044197DCMDCommunity Psychiatric/Mental Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Toller Enterprises LLC Psychiatric/Mental Health CurrentSince Apr 12, 2024 Accepting new patients
Integrahealth LLC Psychiatric/Mental Health CurrentSince Jun 11, 2024 Accepting new patients
Integrahealth LLC Psychiatric/Mental Health CurrentSince Jun 11, 2024 Accepting new patients

Locations

1500 K St NW
Ste 200
Washington, DC 20005
Phone (667) 207-3552

821 N Charles St
Baltimore, MD 21201
Phone (443) 452-9612

2232 E Monument St
Baltimore, MD 21205
Phone (667) 207-3552

10 N Rock Glen Rd
Baltimore, MD 21229
Phone (410) 646-2100

3210 Powder Mill Rd
Hyattsville, MD 20783
Phone (301) 937-3939

9722 Groffs Mill Dr
Owings Mills, MD 21117
Phone (410) 205-9255

200 Civic Ave
Salisbury, MD 21804
Phone (410) 749-1466

Organizations & group practices 4

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": "1336867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1215296157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 NEW YORK AVE NE",
            "address_2": "228",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200021848",
            "telephone_number": "202-832-8340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 PENNSYLVANIA AVE SE STE 330",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200034397",
            "telephone_number": "202-864-4184"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1818 New York Ave NE",
            "address_2": "228",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200021848",
            "country_code": "US",
            "telephone_number": "202-832-8340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MABOH",
        "first_name": "LILIAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-13",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "DC",
            "license": "RN1044197",
            "primary": false
        },
        {
            "code": "364SP0812X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Community",
            "state": "DC",
            "license": "NP1044197",
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R217417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.