NPIMap

Organization Active NPI

Insightful Life Therapeutic Services LLC

  • Community/Behavioral Health Agency
  • Baltimore, MD
National Provider Identifier
1366025678
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
INSIGHTFUL LIFE THERAPEUTIC SERVICES LLC
Practice address
575 S Charles St Ste 140
Baltimore, MD 21201-2477
Phone
(443) 873-7197
Fax
(443) 873-7198
NPI assigned
May 4, 2021
Last updated
May 11, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
INSIGHTFUL LIFE THERAPEUTIC SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Authorized official

Name
Dr. Stanley I Nwogwugwu, PH.D, LCPC, LCADCNPI 1033393202
Title
Program Director
Phone
(443) 873-7197

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

575 S Charles St Ste 140
Baltimore, MD 21201-2477

Mailing address

575 S Charles St Ste 140
Baltimore, MD 21201-2477
Phone (443) 873-7197

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241204003192 MD Part B Supplier - Clinic/Group Practice 9537695226 Receives reassigned benefits from 1 practitioner
Practice locations: Baltimore, MD

National Provider Directory

National Provider Directory
Tax ID family
Insightful Life Therapeutic Services LLC4 organizations share this tax ID, including this one
Part of
Insightful Life Therapeutic Services LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5438 York Rd
Ste 202
Baltimore, MD 21212

Practitioners & affiliated clinicians

Practitioners 1

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": "1620086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1366025678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 S CHARLES ST STE 140",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212012477",
            "telephone_number": "443-873-7197",
            "fax_number": "443-873-7198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 S CHARLES ST STE 140",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212012477",
            "telephone_number": "443-873-7197",
            "fax_number": "443-873-7198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSIGHTFUL LIFE THERAPEUTIC SERVICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INSIGHTFUL LIFE THERAPEUTIC SERVICES, LLC",
        "enumeration_date": "2021-05-04",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "NWOGWUGWU",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "443-873-7197",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D, LCPC,  LCADC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.