NPIMap

Organization Active NPI

Lead4Life, Inc.

  • Psychiatry Physician
  • Rockville, MD
National Provider Identifier
1659850360
Registry record updated Aug 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
LEAD4LIFE, INC.
Practice address
15825 Shady Grove Rd Ste 35
Rockville, MD 20850-4033
Phone
(301) 672-4319
NPI assigned
Aug 13, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2018

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

Authorized official

Name
Jennifer M Gauthier, MSWNPI 1912142753
Title
Executive Director
Phone
(301) 672-4319

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

15825 Shady Grove Rd Ste 35
Rockville, MD 20850-4033

Mailing address

15825 Shady Grove Rd Ste 35
Rockville, MD 20850-4033
Phone (240) 499-8949

Other practice location 1

225 N Division St Ste 204
Salisbury, MD 21801-4302
Phone (301) 672-4319

Other practice location 2

329 S Jefferson St
Frederick, MD 21701-6206
Phone (301) 672-4319

Other identifiers 1

IdentifierTypeStateIssuer
201507200MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Lead4Life Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

329 S Jefferson St
Frederick, MD 21701

225 N Division St
Ste 204
Salisbury, MD 21801
Phone (443) 978-7864

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534118400000",
    "number": "1659850360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15825 SHADY GROVE RD STE 35",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208504033",
            "telephone_number": "240-499-8949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15825 SHADY GROVE RD STE 35",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208504033",
            "telephone_number": "301-672-4319"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 N Division St Ste 204",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218014302",
            "country_code": "US",
            "telephone_number": "301-672-4319",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "329 S Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Frederick",
            "state": "MD",
            "postal_code": "217016206",
            "country_code": "US",
            "telephone_number": "301-672-4319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEAD4LIFE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-13",
        "last_updated": "2018-08-13",
        "status": "A",
        "authorized_official_last_name": "GAUTHIER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "301-672-4319",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201507200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; 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.