NPIMap

Organization Active NPI

Associated Behavioral Health Services, LLC

  • Psychiatry Physician
  • Linthicum, MD
National Provider Identifier
1215448998
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
ASSOCIATED BEHAVIORAL HEALTH SERVICES, LLC
Practice address
939 Elkridge Landing Rd Ste 350
Linthicum, MD 21090-2909
Phone
(443) 354-8903
Fax
(443) 410-0643
NPI assigned
Oct 20, 2017
Reactivated
Aug 25, 2023
Last updated
Aug 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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

Authorized official

Name
Mr. Samuel Todd Bolin Jr., LCSW-CNPI 1598175648
Title
Ceo / Social Worker
Phone
(443) 588-8743

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X NU
Clinical Social Worker 1041C0700X NU
Psychiatric/Mental Health Registered Nurse 163WP0808X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

939 Elkridge Landing Rd Ste 350
Linthicum, MD 21090-2909

Mailing address

939 Elkridge Landing Rd Ste 350
Linthicum, MD 21090-2909
Phone (443) 354-8903

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, NJ, WV3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20180111002034 MD Part B Supplier - Clinic/Group Practice 1951660224 Receives reassigned benefits from 11 practitioners
Practice locations: Linthicum, MD
O20220215000400 NJ Part B Supplier - Clinic/Group Practice 1951660224 Receives reassigned benefits from 1 practitioner
Practice locations: Newfield, NJ
O20220420000305 WV Part B Supplier - Clinic/Group Practice 1951660224 Receives reassigned benefits from 1 practitioner
Practice locations: Hinton, WV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1508457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692921600000",
    "number": "1215448998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "939 ELKRIDGE LANDING RD STE 350",
            "city": "LINTHICUM",
            "state": "MD",
            "postal_code": "210902909",
            "telephone_number": "443-354-8903",
            "fax_number": "443-410-0643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 ELKRIDGE LANDING RD STE 350",
            "city": "LINTHICUM",
            "state": "MD",
            "postal_code": "210902909",
            "telephone_number": "443-354-8903",
            "fax_number": "443-410-0643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED BEHAVIORAL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-20",
        "last_updated": "2023-08-25",
        "certification_date": "2023-07-31",
        "deactivation_date": "2023-07-31",
        "reactivation_date": "2023-08-25",
        "status": "A",
        "authorized_official_last_name": "BOLIN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "CEO / SOCIAL WORKER",
        "authorized_official_telephone_number": "443-588-8743",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Linthicum, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; 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.