NPIMap

Organization Active NPI

Adolescent,Child & Adult Psychiatry

  • Adolescent and Children Mental Health Clinic/Center
  • Raleigh, NC
National Provider Identifier
1457519514
Registry record updated May 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
28114 Issued in NC
Legal business name
ADOLESCENT,CHILD & ADULT PSYCHIATRY
Practice address
4041 Ed Dr # 108
Raleigh, NC 27612-8089
Phone
(919) 783-8377
Fax
(866) 347-8377
NPI assigned
May 27, 2008
Last updated
May 27, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2008

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

Authorized official

Name
Dr. Shaheda Fatima Maroof, M.D.NPI 1558454322
Title
Psychiatrist
Phone
(919) 783-8377

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 28114 NC
Adolescent and Children Mental Health Clinic/Center 261QM0855X 28114 NC Primary

Addresses

Primary practice location

4041 Ed Dr # 108
Raleigh, NC 27612-8089

Mailing address

4041 Ed Dr # 108
Raleigh, NC 27612-8089
Phone (919) 783-8377

Other identifiers 2

IdentifierTypeStateIssuer
8912082MedicaidNC
12082OtherNCBLUE CROSS BLUE SHIELD OF NORTH CAROLINA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110915000090 NC Part B Supplier - Clinic/Group Practice 3375714777 Receives reassigned benefits from 7 practitioners
Practice locations: Raleigh, NC

National Provider Directory

National Provider Directory

Locations

4041 Ed Dr
Raleigh, NC 27612
Phone (919) 324-3385

4041 Ed Dr
Ste 108
Raleigh, NC 27612
Phone (919) 324-3385

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211846400000",
    "number": "1457519514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4041 ED DR # 108",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276128089",
            "telephone_number": "919-783-8377",
            "fax_number": "866-347-8377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4041 ED DR # 108",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276128089",
            "telephone_number": "919-783-8377",
            "fax_number": "866-347-8377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADOLESCENT,CHILD & ADULT PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-27",
        "last_updated": "2008-05-27",
        "status": "A",
        "authorized_official_last_name": "MAROOF",
        "authorized_official_first_name": "SHAHEDA",
        "authorized_official_middle_name": "FATIMA",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "919-783-8377",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NC",
            "license": "28114",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NC",
            "license": "28114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8912082",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF NORTH CAROLINA",
            "identifier": "12082",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; 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.