The House of the Good Shepherd of the City of Baltimore

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

03-049 Issued in MD

Legal business name

THE HOUSE OF THE GOOD SHEPHERD OF THE CITY OF BALTIMORE

Practice address

4100 Maple Avenue
Baltimore, MD 21227-4007

Phone

(410) 247-2770

Fax

(410) 247-3242

NPI assigned

Mar 19, 2007

Organization subpart

No

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

Authorized official

Name

Derrick A. Boone, PSY.D.

Title

President & Ceo

Phone

(410) 247-2770

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Good Shepherd School2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• House of the Good Shepherd Corporation

  • Local Education Agency (LEA)
  • Baltimore, MD
  • NPI 1942570353
  NPD tax ID

Practitioners 2

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

• Francesca Sciscenti, LCSW-C

  • Clinical Social Worker
  • Baltimore, MD
  • NPI 1891117156
  NPD (past)
• Kristin Cole Sorensen-Tanenbaum, NP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Grand Rapids, MN
  • NPI 1992960819
  NPD (past)

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242172800000",
    "number": "1508980251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 MAPLE AVENUE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212274007",
            "telephone_number": "410-247-2770",
            "fax_number": "410-247-3242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 MAPLE AVENUE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212274007",
            "telephone_number": "410-247-2770",
            "fax_number": "410-247-3242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE HOUSE OF THE GOOD SHEPHERD OF THE CITY OF BALTIMORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2009-05-13",
        "status": "A",
        "authorized_official_last_name": "BOONE",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "410-247-2770",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MD",
            "license": "03-049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "427825900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Hearing and Speech Agency
• The Holding Space Group
• The House of Jude Children Services
• The House of Nehemiah
• The House of Nehemiah Outreach and Ministries
• The House Project
• The Hunt Clinic,LLC
• The Improving Quality of Life, LLC
• The Johns Hopkins Home Health Services, Inc.
• The Johns Hopkins Hospital

• Emotionally Disturbed Childrens' Residential Treatment Facility in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; 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.