NPIMap

Organization Active NPI

Eastern Shore Psychological Services, LLC

  • Community/Behavioral Health Agency
  • Easton, MD
National Provider Identifier
1821492646
Registry record updated Mar 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EASTERN SHORE PSYCHOLOGICAL SERVICES, LLC
Practice address
29520 Canvasback Dr
Easton, MD 21601-7124
Phone
(410) 822-5007
Fax
(410) 822-5569
NPI assigned
Oct 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2015

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

Authorized official

Name
Mary Kathryn Seifert, PHD
Title
Executive Ceo
Phone
(410) 334-6961

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

29520 Canvasback Dr
Easton, MD 21601-7124

Mailing address

2336 Goddard Pkwy
Salisbury, MD 21801-1126
Phone (410) 334-6961

Other identifiers 2

IdentifierTypeStateIssuer
609500301MedicaidMD
609500300MedicaidMD

National Provider Directory

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

Other organizations with this tax ID 7

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

Locations

29520 Canvasback Dr
Easton, MD 21601
Phone (410) 822-5007

Ownership & related parties

Subparts reporting this organization as parent 10

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426723200000",
    "number": "1821492646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2336 GODDARD PKWY",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218011126",
            "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": "29520 CANVASBACK DR",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216017124",
            "telephone_number": "410-822-5007",
            "fax_number": "410-822-5569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-22",
        "last_updated": "2015-03-19",
        "status": "A",
        "authorized_official_last_name": "SEIFERT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KATHRYN",
        "authorized_official_title_or_position": "EXECUTIVE CEO",
        "authorized_official_telephone_number": "410-334-6961",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "609500301",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "609500300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Easton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; 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.