NPIMap

Organization Active NPI

Eastern Shore Psychological Services, LLC

  • Addiction (Substance Use Disorder) Counselor
  • Easton, MD
National Provider Identifier
1659630523
Registry record updated Jul 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
EASTERN SHORE PSYCHOLOGICAL SERVICES, LLC
Practice address
29520 Canvasback Dr
Easton, MD 21601-7124
Phone
(410) 822-5007
Fax
(410) 822-5569
NPI assigned
May 11, 2012
Organization subpart
Yes
Parent organization
EASTERN SHORE PSYCHOLOGICAL SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 31, 2012

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

Authorized official

Name
Dr. Mary Kathryn Seifert, PH.D
Title
Executive Ceo
Phone
(410) 334-6961

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X Primary

Addresses

Primary practice location

29520 Canvasback Dr
Easton, MD 21601-7124

Mailing address

2336 Goddard Pkwy
Salisbury, MD 21801-1126
Phone (410) 334-6961

Other identifiers 3

IdentifierTypeStateIssuer
R968OtherMDCAREFIRST BCBS-FEDERAL
520202701MedicaidMD
LM49EAOtherMDCAREFIRST BCBS

National Provider Directory

National Provider Directory
Tax ID family
Eastern Shore Psychological8 organizations share this tax ID, including this one
Part of
Eastern Shore Psychological

Other organizations with this tax ID 7

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1336694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343692800000",
    "number": "1659630523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2336 GODDARD PKWY",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218011126",
            "telephone_number": "410-334-6961",
            "fax_number": "410-334-6362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29520 CANVASBACK DR",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216017124",
            "telephone_number": "410-822-5007",
            "fax_number": "410-822-5569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EASTERN SHORE PSYCHOLOGICAL SERVICES, LLC",
        "enumeration_date": "2012-05-11",
        "last_updated": "2012-07-31",
        "status": "A",
        "authorized_official_last_name": "SEIFERT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KATHRYN",
        "authorized_official_title_or_position": "EXECUTIVE CEO",
        "authorized_official_telephone_number": "410-334-6961",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS-FEDERAL",
            "identifier": "R968",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "520202701",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "LM49EA",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Easton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; 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.