NPIMap

Organization Active NPI

Lifespan Behavioral Health Services PC

  • Psychiatry Physician
  • Olney, MD
National Provider Identifier
1801415443
Registry record updated Apr 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
LIFESPAN BEHAVIORAL HEALTH SERVICES PC
Practice address
3416 Olandwood CT Ste 201
Olney, MD 20832-1373
Phone
(301) 969-4060
NPI assigned
Apr 14, 2020
Organization subpart
Yes
Parent organization
LIFESPAN BEHAVIORAL HEALTH SERVICES PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 14, 2020

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

Authorized official

Name
Carolyn Reidy
Title
Office Admin
Phone
(800) 819-7570

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

3416 Olandwood CT Ste 201
Olney, MD 20832-1373

Mailing address

2705 Silver Hammer Way
Brookeville, MD 20833-3244

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200221000871 DC Part B Supplier - Clinic/Group Practice 4082041637 Receives reassigned benefits from 30 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenbelt, MD; Olney, MD

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Lifespan Behavioral Health

Locations

3460 Olney Laytonsville Rd
Olney, MD 20832
Phone (240) 535-5172

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586822400000",
    "number": "1801415443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 SILVER HAMMER WAY",
            "city": "BROOKEVILLE",
            "state": "MD",
            "postal_code": "208333244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3416 OLANDWOOD CT STE 201",
            "city": "OLNEY",
            "state": "MD",
            "postal_code": "208321373",
            "telephone_number": "301-969-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN BEHAVIORAL HEALTH SERVICES PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFESPAN BEHAVIORAL HEALTH SERVICES PC",
        "enumeration_date": "2020-04-14",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A",
        "authorized_official_last_name": "REIDY",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "OFFICE ADMIN",
        "authorized_official_telephone_number": "800-819-7570"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olney, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; 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.