Ethan Bliss, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

04888 Issued in MD

Practice address

340 Park Ave
Frederick, MD 21701-4931

Phone

(301) 663-1683

Fax

(301) 663-3792

NPI assigned

Feb 28, 2007

Last updated

Nov 22, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

The Center for Integrative Healthcare, LLCGroup PAC ID 7517974256, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Center for Integrative Healthcare, LLC

  • Clinical Social Worker
  • Frederick, MD
  • NPI 1952434730
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290384000000",
    "number": "1851428460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 MANDA DR",
            "city": "MIDDLETOWN",
            "state": "MD",
            "postal_code": "217697853",
            "telephone_number": "301-508-0102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 PARK AVE",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217014931",
            "telephone_number": "301-663-1683",
            "fax_number": "301-663-3792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLISS",
        "first_name": "ETHAN",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-28",
        "last_updated": "2010-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39001937A",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH 7447",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20042437A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "04888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Fernanda Blasco
• Katherine Lee Blaser, LCSW-C
• BLB Counseling
• Bliss Physical Therapy and Wellness, LLC
• Amanda Kaye Bliss, PHYSICIAN ASSISTANT
• Charlene Bloedorn, OTR/L
• Karen Blomberg, SLP
• Bloom & Reddy DDS PC
• Bloom Health NP
• Bloom Healthcare Service LLC

• Clinical Psychologist in Frederick, MD
• Providers in Frederick, MD by specialty
• Clinical Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.