Active NPI
Eboka Mullins, PH.D.
- Psychologist
- Baltimore, MD
National Provider Identifier
1346639713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 05295
- Practice address
- 419 W Redwood St Ste 570
Baltimore, MD 21201-7023 - Phone
- (667) 214-1909
- NPI assigned
- Jan 22, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 05295 | MD | Primary |
| Psychologist | 103T00000X | 019927 | NY |
Addresses
Primary practice location
419 W Redwood St Ste 570
Baltimore, MD 21201-7023
Mailing address
1800 N Charles St Ste 406
Baltimore, MD 21201-5909
Phone (438) 353-8754
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05295 | MD | MD | Speech-Language Pathologist |
| 019927 | NY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maryland Group Faculty Practice LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Baltimore, MD
- NPI 1104036300
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651795200000",
"number": "1346639713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 N CHARLES ST STE 406",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212015909",
"telephone_number": "438-353-8754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "419 W REDWOOD ST STE 570",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212017023",
"telephone_number": "667-214-1909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLINS",
"first_name": "EBOKA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-01-22",
"last_updated": "2022-05-06",
"certification_date": "2022-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MD",
"license": "05295",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "019927",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
- Michael E Mulligan, MD
- Gerard Mullin, M.D.
- Dixie Marie Mullineaux, LAC.,MAC
- Amanda Mullins, CRNP-PMH
- Clinton Mullins, OTD, OTR/L
- Katherine Wachter Mullins
- Benjamin Joseph Mulqueen
- Multifold Healthcare Services Inc.
- Multiple Care & Community Support Services, Inc
- Multiple Health and Behavioral Care Services Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.