NPIMap

Organization Active NPI

Fresh Start Recovery

Doing business as Fresh Start Center

  • Addiction (Substance Use Disorder) Psychologist
  • Gaithersburg, MD
National Provider Identifier
1366981672
Registry record updated Feb 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X
License
D0046457 Issued in MD
Legal business name
FRESH START RECOVERY
Doing business as
Fresh Start Center
Practice address
15886 Gaither Dr
Gaithersburg, MD 20877-1404
Phone
(954) 234-2469
Fax
(954) 234-2469
NPI assigned
Feb 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2017

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

Authorized official

Name
Cathy Picillo
Title
Office Manager
Phone
(954) 234-2469

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TA0400X D0046457 MD Primary

Addresses

Primary practice location

15886 Gaither Dr
Gaithersburg, MD 20877-1404

Mailing address

15886 Gaither Dr
Gaithersburg, MD 20877-1404
Phone (954) 234-2469

Other identifiers 1

IdentifierTypeStateIssuer
D0046457OtherFLSTATE

Other names 1

  • FRESH START CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fresh Start Recovery Lab4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1487548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1366981672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15886 GAITHER DR",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208771404",
            "telephone_number": "954-234-2469",
            "fax_number": "954-234-2469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15886 GAITHER DR",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208771404",
            "telephone_number": "954-234-2469",
            "fax_number": "954-234-2469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH START RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-20",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "PICILLO",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "954-234-2469"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": "D0046457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE",
            "identifier": "D0046457",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FRESH START CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; 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.