Moa Psychiatric Practice LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MOA PSYCHIATRIC PRACTICE LLC

Practice address

28 Flint Dr
North East, MD 21901-3746

Phone

(240) 997-0287

NPI assigned

Oct 24, 2023

Last updated

Oct 24, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Olumide Mesioye

Title

President

Phone

(240) 997-0287

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1698105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698105600000",
    "number": "1295507127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 FLINT DR",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219013746",
            "telephone_number": "240-997-0287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 FLINT DR",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219013746",
            "telephone_number": "240-997-0287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOA PSYCHIATRIC PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-24",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A",
        "authorized_official_last_name": "MESIOYE",
        "authorized_official_first_name": "OLUMIDE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "240-997-0287"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenduanyi Menkem
• Kathleen Miller, PT
• Tyler Francis Miller
• Taylor Minderlein, ATC
• MNR Industries, LLC (ExpressCare of North East)
• Kay P Moore, PSYD
• Shana Moorefield, LGSW
• Constance Muller-Thym, LCSW-C
• Neema Home Care Services LLC
• Nicole Nimmons, LMFT

• Mental Health Clinic/Center (Including Community Mental Health Center) in North East, MD
• Providers in North East, MD by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; 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.