Marybeth Blood

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

26NJ01123100 Issued in NJ

Practice address

111 State Route 35
Cliffwood, NJ 07721-1512

Phone

(732) 727-2555

NPI assigned

Jun 3, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• JLS Medical PC

  • Psychiatry Physician
  • Newark, NJ
  • NPI 1164007043
  Medicare reassignment
• Bancroft, a New Jersey Nonprofit Corporation

  • Rehabilitation Clinic/Center
  • Cherry Hill, NJ
  • NPI 1720121106
  NPD (past)
• Habit Opco, LLC

  • Methadone Clinic
  • Cliffwood, NJ
  • NPI 1386888279
  NPD (past)

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

{
    "created_epoch": "1622678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680480000000",
    "number": "1396311932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 E SHORE RD",
            "city": "DENVILLE",
            "state": "NJ",
            "postal_code": "078342026",
            "telephone_number": "862-242-9412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 STATE ROUTE 35",
            "city": "CLIFFWOOD",
            "state": "NJ",
            "postal_code": "077211512",
            "telephone_number": "732-727-2555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 Broad St Ste 606",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "NJ",
            "postal_code": "071024537",
            "country_code": "US",
            "telephone_number": "201-822-1161",
            "fax_number": "877-485-8918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLOOD",
        "first_name": "MARYBETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-03",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ01123100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0856924",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Somaya Banaei
• Kathryn Barrella, RN
• Bridget Basis, LCSW
• Stevens M Bass, RPH
• Cherika L Blake
• Brianna Boham
• Michael A Bolen, NCC
• Donna Bondi, RN
• Nordia Campbell
• Emely Castillo, CADC

• Psychiatric/Mental Health Nurse Practitioner in Cliffwood, NJ
• Providers in Cliffwood, NJ by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.