Marita Atehakoh Formin, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R249853 Issued in MD

Practice address

7375 Executive PL
Lanham, MD 20706-2278

Phone

(202) 940-2022

NPI assigned

Dec 31, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Marita Atehakoh Formin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

BCB Liberty Health Care LLCGroup PAC ID 8426428301, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Demar Behavioral Health and Wellness Clinic LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Lanham, MD
  • NPI 1427983865
  NPD Authorized official
• BCB Liberty Health Care LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baltimore, MD
  • NPI 1518688100
  Care Compare group

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

{
    "created_epoch": "1451520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784505600000",
    "number": "1568827855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7375 EXECUTIVE PL STE 200",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207066234",
            "telephone_number": "202-940-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7375 EXECUTIVE PL",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207062278",
            "telephone_number": "202-940-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMIN",
        "first_name": "MARITA",
        "middle_name": "ATEHAKOH",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-31",
        "last_updated": "2026-07-20",
        "certification_date": "2026-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R249853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARITA",
            "last_name": "FORMIN",
            "middle_name": "ATEHAKOH",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bazil Tanjuh Forkoh
• Sylvia Forku
• Micah Forkum
• Frankline Forkwa
• Mercy Forlu
• Fnu Forten Honorine Anyizie
• Fortune Home Health, LLC
• Shonna D Foster
• Beatrice Fotachwi
• Christian Dobgima Fotachwi

• Psychiatric/Mental Health Nurse Practitioner in Lanham, MD
• Providers in Lanham, 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 Jul 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.