NPIMap

Organization Active NPI

Bluefish Behavioral Health

  • Community/Behavioral Health Agency
  • Waldorf, MD
National Provider Identifier
1679206080
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
BLUEFISH BEHAVIORAL HEALTH
Practice address
3261 Old Washington Rd Ste 2020
Waldorf, MD 20602-3231
Phone
(240) 780-8254
NPI assigned
Jul 4, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Authorized official

Name
Dr. Jessica Peck, PSYDNPI 1750630851
Title
Owner
Phone
(240) 780-8254

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
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

3261 Old Washington Rd Ste 2020
Waldorf, MD 20602-3231

Mailing address

PO Box 575
Port Tobacco, MD 20677-0575

National Provider Directory

National Provider Directory

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": "1656892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1679206080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 575",
            "city": "PORT TOBACCO",
            "state": "MD",
            "postal_code": "206770575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3261 OLD WASHINGTON RD STE 2020",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023231",
            "telephone_number": "240-780-8254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEFISH BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-04",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "PECK",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-780-8254",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

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