NPIMap

Organization Active NPI

Eastern Shore Psychological Service, LLC

  • Community/Behavioral Health Agency
  • Princess Anne, MD
National Provider Identifier
1730252537
Registry record updated Aug 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EASTERN SHORE PSYCHOLOGICAL SERVICE, LLC
Practice address
11120 Somerset Ave
Princess Anne, MD 21853-2970
Phone
(410) 651-4200
Fax
(410) 651-4290
NPI assigned
Nov 17, 2006
Organization subpart
Yes
Parent organization
EASTERN SHORE PSYCHOLOGICAL SERVICE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 4, 2014

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

Authorized official

Name
Dr. Mary Kathyrn Seifert, PHDNPI 1164510178
Title
Executive Director Ceo
Phone
(410) 334-6961

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 MD Primary

Addresses

Primary practice location

11120 Somerset Ave
Princess Anne, MD 21853-2970

Mailing address

2336 Goddard Parkway
Salisbury, MD 21801
Phone (410) 334-6961

Other identifiers 5

IdentifierTypeStateIssuer
259147000OtherMDMAGELLAN GROUP
609500303MedicaidMD
R968OtherDCCAREFIRST FEDERAL GROUP
LM49EAOtherMDCAREFIRST BCBS GROUP
517251OtherUHC MAMSI GROUP

National Provider Directory

National Provider Directory
Tax ID family
Eastern Shore Psychological8 organizations share this tax ID, including this one
Part of
Eastern Shore Psychological

Other organizations with this tax ID 7

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 43

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

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407110400000",
    "number": "1730252537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2336 GODDARD PARKWAY",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "21801",
            "telephone_number": "410-334-6961",
            "fax_number": "410-334-6362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11120 SOMERSET AVE",
            "city": "PRINCESS ANNE",
            "state": "MD",
            "postal_code": "218532970",
            "telephone_number": "410-651-4200",
            "fax_number": "410-651-4290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE PSYCHOLOGICAL SERVICE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EASTERN SHORE PSYCHOLOGICAL SERVICE, LLC",
        "enumeration_date": "2006-11-17",
        "last_updated": "2014-08-04",
        "status": "A",
        "authorized_official_last_name": "SEIFERT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KATHYRN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR CEO",
        "authorized_official_telephone_number": "410-334-6961",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN GROUP",
            "identifier": "259147000",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "609500303",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST FEDERAL GROUP",
            "identifier": "R968",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS GROUP",
            "identifier": "LM49EA",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC MAMSI GROUP",
            "identifier": "517251",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Princess Anne, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.