Active NPI
Tebine J Otubu
- Social Worker
- Waldorf, MD
National Provider Identifier
1831955178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 30836
- Practice address
- 1036 Saint Nicholas Dr Unit 102
Waldorf, MD 20603-4758 - Phone
- (410) 934-0580
- NPI assigned
- Feb 26, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 30836 | MD | Primary |
Addresses
Primary practice location
1036 Saint Nicholas Dr Unit 102
Waldorf, MD 20603-4758
Mailing address
1036 Saint Nicholas Dr Unit 102
Waldorf, MD 20603-4758
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30836 | MD | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| One Alkaline Life, LLC | Current | Accepting new patients | |
| One Alkaline Life LLC | Current | Accepting new patients |
Locations
1036 Saint Nicholas Dr
Unit 102
Waldorf, MD 20603
Phone (410) 934-0580
Organizations & group practices 2
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.
-
- Mental Health Counselor
- Waldorf, MD
- NPI 1801777313
-
- Mental Health Counselor
- Waldorf, MD
- NPI 1104572775
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708905600000",
"number": "1831955178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1036 SAINT NICHOLAS DR UNIT 102",
"city": "WALDORF",
"state": "MD",
"postal_code": "206034758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1036 SAINT NICHOLAS DR UNIT 102",
"city": "WALDORF",
"state": "MD",
"postal_code": "206034758",
"telephone_number": "410-934-0580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTUBU",
"first_name": "TEBINE",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-26",
"last_updated": "2024-02-26",
"certification_date": "2024-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MD",
"license": "30836",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waldorf, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.