NPIMap

Organization Active NPI

Optimum Behavioral Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Newburgh, NY
National Provider Identifier
1700575677
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
OPTIMUM BEHAVIORAL SERVICES LLC
Practice address
5020 Route 9W Ste 103
Newburgh, NY 12550-7901
Phone
(443) 557-8519
NPI assigned
May 5, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Authorized official

Name
Mutinta Chestnut, PMHNPNPI 1427320159
Title
Medical Director
Phone
(443) 557-8519

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
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

5020 Route 9W Ste 103
Newburgh, NY 12550-7901

Mailing address

6340 Security Blvd Ste B-56
Woodlawn, MD 21207-5173
Phone (443) 557-8519

Other practice location 1

6340 Security Blvd Ste B-56
Woodlawn, MD 21207-5173
Phone (443) 557-8519

Other names 1

  • home office Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230728002509 MD Part B Supplier - Clinic/Group Practice 4385005974 Receives reassigned benefits from 2 practitioners
Practice locations: Woodlawn, MD

National Provider Directory

National Provider Directory

Locations

6340 Security Blvd
Ste B56
Woodlawn, MD 21207
Phone (443) 531-4264

Practitioners & affiliated clinicians

Practitioners 3

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": "1683244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1700575677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6340 SECURITY BLVD STE B-56",
            "city": "WOODLAWN",
            "state": "MD",
            "postal_code": "212075173",
            "telephone_number": "443-557-8519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5020 ROUTE 9W STE 103",
            "city": "NEWBURGH",
            "state": "NY",
            "postal_code": "125507901",
            "telephone_number": "443-557-8519"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6340 Security Blvd Ste B-56",
            "address_purpose": "LOCATION",
            "city": "Woodlawn",
            "state": "MD",
            "postal_code": "212075173",
            "country_code": "US",
            "telephone_number": "443-557-8519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPTIMUM BEHAVIORAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-05",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "CHESTNUT",
        "authorized_official_first_name": "MUTINTA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "443-557-8519",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "home office",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "home office",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Newburgh, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.