Peacock Autism

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

PEACOCK AUTISM

Practice address

6818 Fordcrest Rd
Rosedale, MD 21237-2187

Phone

(443) 636-6003

Fax

(443) 684-2809

NPI assigned

Mar 15, 2025

Organization subpart

No

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

Authorized official

Name

Poonam Nandal

Title

Owner

Phone

(302) 306-4395

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1741996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741996800000",
    "number": "1275333569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6818 FORDCREST RD",
            "city": "ROSEDALE",
            "state": "MD",
            "postal_code": "212372187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6818 FORDCREST RD",
            "city": "ROSEDALE",
            "state": "MD",
            "postal_code": "212372187",
            "telephone_number": "443-636-6003",
            "fax_number": "443-684-2809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACOCK AUTISM",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-15",
        "last_updated": "2025-03-15",
        "certification_date": "2025-03-15",
        "status": "A",
        "authorized_official_last_name": "NANDAL",
        "authorized_official_first_name": "POONAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "302-306-4395"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Maria Passos, LCPC
• Harron Patel
• Pathfinder Health Solutions
• Cheryl Beth Patterson, PTA
• Sierra Autumn Paul, LMSW
• Kathleen K Pear, LCSW-C
• Annamarie Pemberton, LGPC
• Victoria M Pender, CRNP
• Cabria Perry, LMSW
• Jennifer Lynne Perry, FNP-BC

• Behavior Analyst in Rosedale, MD
• Providers in Rosedale, MD by specialty
• Behavior Analyst in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.