Island Care Mental Health

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

R056757 Issued in MD

Legal business name

ISLAND CARE MENTAL HEALTH

Doing business as

Island Care Mental Health
Mary Deborah Wilson PMHNP

Practice address

11022 Nicholas Lane
Unit 2 Suite1 Village Square Center
Berlin, MD 21811-1663

Phone

(443) 513-0222

NPI assigned

Jul 3, 2017

Organization subpart

No

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

Authorized official

Name

Mary Deborah Wilson, PMHNPNPI 1306051313

Title

Sole Provider

Phone

(410) 641-5190

Specialties & licenses 3

Addresses

Other names 2

• Island Care Mental Health Doing business as
• Mary Deborah Wilson PMHNP Doing business as

Locations

Practitioners 1

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

• Mary Deborah Wilson, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Berlin, MD
  • NPI 1306051313
  NPD Authorized official

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

{
    "created_epoch": "1499040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1619498383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11022 NICHOLAS LANE",
            "address_2": "UNIT 2 SUITE 1 VILLAGE SQUARE CENTER",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218111663",
            "telephone_number": "410-641-5190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11022 NICHOLAS LANE",
            "address_2": "UNIT 2 SUITE1 VILLAGE SQUARE CENTER",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218111663",
            "telephone_number": "443-513-0222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "142 Nottingham Ln",
            "address_purpose": "LOCATION",
            "city": "Berlin",
            "state": "MD",
            "postal_code": "218111663",
            "country_code": "US",
            "telephone_number": "443-513-0222",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "142 Nottingham Ln",
            "address_purpose": "LOCATION",
            "city": "Berlin",
            "state": "MD",
            "postal_code": "218111663",
            "country_code": "US",
            "telephone_number": "443-513-0222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ISLAND CARE MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "DEBORAH",
        "authorized_official_title_or_position": "SOLE PROVIDER",
        "authorized_official_telephone_number": "410-641-5190",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "R056757",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MD",
            "license": "R056757",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "MD",
            "license": "R056757",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Island Care Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mary Deborah Wilson PMHNP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tonya Lee Hurley
• Destiny Monae Hynson
• Brandy L Inkrote Taylor, PHARMD
• Liezl G. Irisari, M.D.
• Amanda Irwin, DPT
• Scott Louis Itzkowitz, D.O.
• IV Solutions LLC
• Devvon Jackson
• Jaime Coates Therapy Services, LLC
• Manoj Jain, MD

• Psychiatry Physician in Berlin, MD
• Providers in Berlin, MD by specialty
• Psychiatry Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.