Forward Mental Health & Wellness

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

FORWARD MENTAL HEALTH & WELLNESS

Practice address

9500 Medical Center Dr Ste 432
Largo, MD 20774-3716

Phone

(410) 245-4474

NPI assigned

Jan 5, 2021

Last updated

Jan 5, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alicia Medina, CRNPNPI 1164856043

Title

Owner

Phone

(410) 245-4474

Specialties & licenses 1

Addresses

Other names 1

• Medina Psychiatry & Substance Abuse Former legal business name

Practitioners 1

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.

• Alicia Lajuan Medina, CRNP

  • Psychiatric/Mental Health Nurse Practitioner
  • White Marsh, MD
  • NPI 1164856043
  NPD Authorized official

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

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609804800000",
    "number": "1548858590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 MEDICAL CENTER DR STE 432",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207743716",
            "telephone_number": "410-245-4474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 MEDICAL CENTER DR STE 432",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207743716",
            "telephone_number": "410-245-4474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORWARD MENTAL HEALTH & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-04",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-245-4474",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medina Psychiatry & Substance Abuse",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Psychiatric/Mental Health Nurse Practitioner in Largo, MD
• Providers in Largo, 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 Jan 5, 2021; 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.