Ferdinand Ogbonnaya Ezenwachi

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LC11943 Issued in MD

Practice address

141 N Hickory Ave
Bel Air, MD 21014-3239

Phone

(240) 476-5883

NPI assigned

Nov 1, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1667260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667260800000",
    "number": "1366159162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 N HICKORY AVE",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210143239",
            "telephone_number": "240-476-5883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 N HICKORY AVE",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210143239",
            "telephone_number": "240-476-5883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZENWACHI",
        "first_name": "FERDINAND",
        "middle_name": "OGBONNAYA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-01",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LC11943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fezenwachi@sjerc.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "141 N Hickory Ave",
            "city": "Bel Air",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210143239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.

Verify at the official NPI Registry.