NPIMap

Organization Active NPI

Mentor MD

  • Adolescent and Children Mental Health Clinic/Center
  • Lanham, MD
National Provider Identifier
1659316636
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
2012 Issued in MD
Legal business name
MENTOR MD
Practice address
4501 Forbes Blvd
Suite 140
Lanham, MD 20706-4326
Phone
(301) 459-3057
Fax
(301) 731-3142
NPI assigned
Jun 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Edward Matricardi, LCSW - C
Title
State Director
Phone
(443) 543-2101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 2012 MD Primary

Addresses

Primary practice location

4501 Forbes Blvd
Suite 140
Lanham, MD 20706-4326

Mailing address

4501 Forbes Blvd
Suite 140
Lanham, MD 20706-4326
Phone (301) 459-3057

National Provider Directory

National Provider Directory
Tax ID family
Mentor-Maryland6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659316636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 FORBES BLVD",
            "address_2": "SUITE 140",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207064326",
            "telephone_number": "301-459-3057",
            "fax_number": "301-731-3142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 FORBES BLVD",
            "address_2": "SUITE 140",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207064326",
            "telephone_number": "301-459-3057",
            "fax_number": "301-731-3142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTOR MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MATRICARDI",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "STATE DIRECTOR",
        "authorized_official_telephone_number": "443-543-2101",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW - C"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MD",
            "license": "2012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lanham, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.