NPIMap

Organization Active NPI

Lighthouse, Inc.

  • Mental Health Counselor
  • Baltimore, MD
National Provider Identifier
1790112746
Registry record updated Jun 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
LIGHTHOUSE, INC.
Practice address
60 Mellor Ave
Baltimore, MD 21228-5104
Phone
(410) 788-5483
Fax
(410) 788-5486
NPI assigned
Oct 7, 2013
Last updated
Jun 11, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2015

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

Authorized official

Name
Mr. Drew Carberry
Title
Executive Director
Phone
(410) 788-5483

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

60 Mellor Ave
Baltimore, MD 21228-5104

Mailing address

60 Mellor Ave
Baltimore, MD 21228-5104
Phone (410) 788-5483

Other identifiers 1

IdentifierTypeStateIssuer
BD70OtherMDCAREFIRST BCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250203003121 MD Part B Supplier - Clinic/Group Practice 5890225007 Receives reassigned benefits from 1 practitioner
Practice locations: Catonsville, MD

National Provider Directory

National Provider Directory

Locations

60 Mellor Ave
Catonsville, MD 21228
Phone (410) 788-5483

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1381104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433980800000",
    "number": "1790112746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MELLOR AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212285104",
            "telephone_number": "410-788-5483",
            "fax_number": "410-788-5486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MELLOR AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212285104",
            "telephone_number": "410-788-5483",
            "fax_number": "410-788-5486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-07",
        "last_updated": "2015-06-11",
        "status": "A",
        "authorized_official_last_name": "CARBERRY",
        "authorized_official_first_name": "DREW",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "410-788-5483",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "BD70",
            "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 Jun 11, 2015; 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.