Active NPI
Rakeeda Commodore
- Clinical Social Worker
- Port Republic, MD
National Provider Identifier
1366830465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 1925 Scientists Cliffs Rd
Port Republic, MD 20676-2405 - Phone
- (410) 474-6546
- NPI assigned
- Dec 26, 2014
- Last updated
- Nov 18, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | NU | ||
| Clinical Social Worker | 1041C0700X | NU | Primary |
Addresses
Primary practice location
1925 Scientists Cliffs Rd
Port Republic, MD 20676-2405
Mailing address
1925 Scientists Cliffs Rd
Port Republic, MD 20676-2405
Phone (410) 474-6546
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bootsie Center, LLC | Current | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Bootsie Center
- Community/Behavioral Health Agency
- Port Republic, MD
- NPI 1730903220
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1419552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731888000000",
"number": "1366830465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1925 SCIENTISTS CLIFFS RD",
"city": "PORT REPUBLIC",
"state": "MD",
"postal_code": "206762405",
"telephone_number": "410-474-6546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1925 SCIENTISTS CLIFFS RD",
"city": "PORT REPUBLIC",
"state": "MD",
"postal_code": "206762405",
"telephone_number": "410-474-6546"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COMMODORE",
"first_name": "RAKEEDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-12-26",
"last_updated": "2024-11-18",
"certification_date": "2024-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Republic, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.