NPIMap

Organization Active NPI

Maryland Wellness LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lanham, MD
National Provider Identifier
1851348536
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
MARYLAND WELLNESS LLC
Practice address
4200 Forbes Blvd
Ste 104
Lanham, MD 20706-4342
Phone
(301) 429-6100
Fax
(301) 429-1333
NPI assigned
May 28, 2006
Last updated
Apr 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Authorized official

Name
Sierra Burley
Title
Credentialing Specialist
Phone
(410) 314-1030

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Psychiatry Physician 2084P0800X NU

Addresses

Primary practice location

4200 Forbes Blvd
Ste 104
Lanham, MD 20706-4342

Mailing address

4128 Hayward Ave
Baltimore, MD 21215-4340
Phone (410) 241-6317

Other identifiers 3

IdentifierTypeStateIssuer
415169100MedicaidMD
415169101MedicaidMD
415169102MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200611002298 MD Part B Supplier - Clinic/Group Practice 6406278803 Receives reassigned benefits from 28 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baltimore, MD; Cumberland, MD; Hagerstown, MD; Waldorf, MD

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Alek's House LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744761600000",
    "number": "1851348536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4128 HAYWARD AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212154340",
            "telephone_number": "410-241-6317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 FORBES BLVD",
            "address_2": "STE 104",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207064342",
            "telephone_number": "301-429-6100",
            "fax_number": "301-429-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A",
        "authorized_official_last_name": "BURLEY",
        "authorized_official_first_name": "SIERRA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "410-314-1030"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "415169100",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "415169101",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "415169102",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lanham, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2025; 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.