Body Mind & Soul Family Services, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

BODY MIND & SOUL FAMILY SERVICES, LLC

Practice address

1401 Madison Park Dr Ste 201
Glen Burnie, MD 21061-5881

Phone

(240) 620-6883

NPI assigned

Jun 30, 2019

Organization subpart

No

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

Authorized official

Name

Ms. Bobbi Howard, M.H.A.

Title

Director

Phone

(667) 325-7036

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Esther Opemipo Shadare, DNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Glen Burnie, MD
  • NPI 1245609775
  Medicare reassignment NPD

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

{
    "created_epoch": "1561852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1508428541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 MADISON PARK DR STE 201",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615881",
            "telephone_number": "240-620-6883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MADISON PARK DR STE 201",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615881",
            "telephone_number": "240-620-6883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODY MIND & SOUL FAMILY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-30",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "BOBBI",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "667-325-7036",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.H.A."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110595700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larry Webster Blum, M.D.
• Bna Behavioral Health LLC
• Jeffrey Lee Bober, DPM
• Kathryn Leigh Bocchino, LMSW
• Anuradha Boddeti, M.D.
• Brandi M Bolden
• Blair Bonner
• Dorothy Boo, M.D.
• Cristina Boogaart, DPT
• Jonathan Booth

• Psychiatric/Mental Health Nurse Practitioner in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; 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.