NPIMap

Organization Active NPI

Collaborative Concepts of Maryland, LLC

  • Community/Behavioral Health Agency
  • Baltimore, MD
National Provider Identifier
1699182782
Registry record updated Jul 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
13183 Issued in MD
Legal business name
COLLABORATIVE CONCEPTS OF MARYLAND, LLC
Practice address
1200 W Baltimore St
Suite 202 and 204
Baltimore, MD 21223-2601
Phone
(443) 873-8258
NPI assigned
Jul 21, 2014
Last updated
Jul 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2014

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

Authorized official

Name
Dr. Shirley Newton-Guest, LCSW-C, LICSW
Title
Director and Co-Founder
Phone
(443) 873-8258

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 13183 MD Primary

Addresses

Primary practice location

1200 W Baltimore St
Suite 202 and 204
Baltimore, MD 21223-2601

Mailing address

1200 W Baltimore St
Suite 202 and 204
Baltimore, MD 21223-2601
Phone (443) 873-8258

Other identifiers 2

IdentifierTypeStateIssuer
062835200MedicaidMD
58974800OtherMDMAGELLAN HEALTH

National Provider Directory

National Provider Directory
Tax ID family
Collaborative Concepts of Maryland2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1200 W Baltimore St
Ste 202
Baltimore, MD 21223
Phone (443) 873-8258

NPI Registry JSON

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

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405900800000",
    "number": "1699182782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W BALTIMORE ST",
            "address_2": "SUITE 202 AND 204",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212232601",
            "telephone_number": "443-873-8258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W BALTIMORE ST",
            "address_2": "SUITE 202 AND 204",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212232601",
            "telephone_number": "443-873-8258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLABORATIVE CONCEPTS OF MARYLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-21",
        "last_updated": "2014-07-21",
        "status": "A",
        "authorized_official_last_name": "NEWTON-GUEST",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "DIRECTOR AND CO-FOUNDER",
        "authorized_official_telephone_number": "443-873-8258",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LCSW-C, LICSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MD",
            "license": "13183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "062835200",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN HEALTH",
            "identifier": "58974800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; 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.