Individual provider Active NPI

Constance Austin Coates Quezada, PHD

  • Clinical Psychologist
  • Baltimore, MD
National Provider Identifier
1477241685
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
01788 Issued in MD
Practice address
600 N Wolfe St
Baltimore, MD 21264-0010
Phone
(410) 955-5080
NPI assigned
Apr 26, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 01788 MD Primary

Addresses

Primary practice location

600 N Wolfe St
Baltimore, MD 21264-0010

Mailing address

6201 Greenleigh Ave
Baltimore, MD 21220-2004
Phone (410) 933-6340

Other practice location 1

707 N Broadway
Baltimore, MD 21205-1832
Phone (443) 944-4676

Other practice location 2

1800 Orleans St
Baltimore, MD 21287-0010
Phone (410) 955-5000

Other practice location 3

1741 Ashland Ave Rm 646
Baltimore, MD 21205-1531
Phone (443) 944-4676

Other names 1

  • Constance Austin Coates Quezada Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241115003673 MD Practitioner - Clinical Psychologist 0446784144 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
01788MDMDClinical Psychologist
07188MDMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Krieger Associates CurrentSince Oct 21, 2024 Accepting new patients
Kennedy Krieger Associates CurrentSince Oct 21, 2024 Accepting new patients

Locations

707 N Broadway
Baltimore, MD 21205
Phone (443) 923-1870

1741 Ashland Ave
Ste 642
Baltimore, MD 21205

1741 Ashland Ave
Rm 646
Baltimore, MD 21205
Phone (443) 923-1842

600 N Wolfe St
Baltimore, MD 21287

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1682467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1477241685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6201 GREENLEIGH AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212202004",
            "telephone_number": "410-933-6340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N WOLFE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212640010",
            "telephone_number": "410-955-5080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 N Broadway",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212051832",
            "country_code": "US",
            "telephone_number": "443-944-4676",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1800 Orleans St",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212870010",
            "country_code": "US",
            "telephone_number": "410-955-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1741 Ashland Ave Rm 646",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212051531",
            "country_code": "US",
            "telephone_number": "443-944-4676",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "QUEZADA",
        "first_name": "CONSTANCE",
        "middle_name": "AUSTIN COATES",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-26",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "01788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CONSTANCE",
            "last_name": "QUEZADA",
            "middle_name": "AUSTIN COATES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.