Individual provider Active NPI

Elizabeth Renee Disney, PH.D.

  • Psychologist
  • Columbia, MD
National Provider Identifier
1770505331
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
04064 Issued in MD
Practice address
6325 Woodside CT Ste 350
Columbia, MD 21046-1042
Phone
(410) 910-9660
NPI assigned
Jul 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 04064 MD
Psychologist 103T00000X 04064 MD Primary

Addresses

Primary practice location

6325 Woodside CT Ste 350
Columbia, MD 21046-1042

Mailing address

6325 Woodside CT Ste 350
Columbia, MD 21046-1042
Phone (410) 910-9660

Other identifiers 1

IdentifierTypeStateIssuer
521316900MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050907001038 MD Practitioner - Clinical Psychologist 0840222121 Reassigns benefits to 1 organization
I20220810000553 DC Practitioner - Clinical Psychologist 0840222121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Psychcare Psychological Services LLCGroup PAC ID 2264660133, 19 clinicians

Practice addresses (Care Compare)

12501 Prosperity Dr
Suite 310
Silver Spring, MD 20904-1699
Phone (410) 343-9756

6325 Woodside CT
Suite 350
Columbia, MD 21046-1042
Phone (410) 910-9660

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Psychcare Psychological Services, LLC CurrentSince Aug 15, 2022 Accepting new patients

Locations

6325 Woodside Ct
Ste 350
Columbia, MD 21046
Phone 41034397569

104 Church Ln
Ste 101102
Pikesville, MD 21208
Phone (410) 343-9756

104 Church Ln
Ste 101
Pikesville, MD 21208
Phone (410) 343-9756

12501 Prosperity Dr
Ste 310
Silver Spring, MD 20904
Phone (240) 780-8884

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1770505331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6325 WOODSIDE CT STE 350",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210461042",
            "telephone_number": "410-910-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6325 WOODSIDE CT STE 350",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210461042",
            "telephone_number": "410-910-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISNEY",
        "first_name": "ELIZABETH",
        "middle_name": "RENEE",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": "04064",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MD",
            "license": "04064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "521316900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

Verify at the official NPI Registry.