Atlantic Psychological Practice, P.a.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Legal business name

ATLANTIC PSYCHOLOGICAL PRACTICE, P.A.

Practice address

106 Milford St
Suite 104
Salisbury, MD 21804-6953

Phone

(410) 543-8291

Fax

(410) 341-6275

NPI assigned

Jan 8, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mark R Todd, PH.D.

Title

Owner

Phone

(410) 543-8291

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

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

• Tara Sterling Ford, LCSW-C

  • Clinical Social Worker
  • Salisbury, MD
  • NPI 1588869796
  NPD
• Motunrayo Tuntun Etteyit, CRNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Salisbury, MD
  • NPI 1558829481
  NPD (past)
• Lee Ann Kenney-Shoup, LCPC

  • Professional Counselor
  • Salisbury, MD
  • NPI 1174668669
  NPD (past)

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237939200000",
    "number": "1689722019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 MILFORD ST",
            "address_2": "SUITE 104",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218046953",
            "telephone_number": "410-543-8291",
            "fax_number": "410-341-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 MILFORD ST",
            "address_2": "SUITE 104",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218046953",
            "telephone_number": "410-543-8291",
            "fax_number": "410-341-6275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC PSYCHOLOGICAL PRACTICE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2009-03-25",
        "status": "A",
        "authorized_official_last_name": "TODD",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-543-8291",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "408242700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Salisbury, MD
• Clinical Child & Adolescent Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2009; 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.