NPIMap

Organization Active NPI

Blue Creek Psychotherapy LLC

  • Clinical Social Worker
  • Pottstown, PA
National Provider Identifier
1801454129
Registry record updated Jun 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
BLUE CREEK PSYCHOTHERAPY LLC
Practice address
900 Heritage Dr Ste 910
Pottstown, PA 19464-9223
Phone
(484) 433-2025
NPI assigned
Jun 1, 2019
Last updated
Jun 1, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2019

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

Authorized official

Name
Mark Merryman, LCSWNPI 1932341468
Title
Co-Owner
Phone
(484) 433-2025

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
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

900 Heritage Dr Ste 910
Pottstown, PA 19464-9223

Mailing address

117 Cobblestone Dr
Gilbertsville, PA 19525-8844
Phone (484) 433-2025

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191017000201 PA Part B Supplier - Clinic/Group Practice 0446581771 Receives reassigned benefits from 8 practitioners
Practice locations: Pottstown, PA

National Provider Directory

National Provider Directory

Locations

900 Heritage Dr
Ste 910
Pottstown, PA 19464
Phone (484) 948-1230

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1559347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559347200000",
    "number": "1801454129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 COBBLESTONE DR",
            "city": "GILBERTSVILLE",
            "state": "PA",
            "postal_code": "195258844",
            "telephone_number": "484-433-2025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 HERITAGE DR STE 910",
            "city": "POTTSTOWN",
            "state": "PA",
            "postal_code": "194649223",
            "telephone_number": "484-433-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE CREEK PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-01",
        "last_updated": "2019-06-01",
        "status": "A",
        "authorized_official_last_name": "MERRYMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "484-433-2025",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pottstown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2019; 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.